Long-term consequences of fracture of the lower leg: Cross-sectional studyand long-term longitudinal follow-up of bone mineral density in the hip after fracture of lower leg

The purpose of this study was to investigate whether bone loss in the hip, occurring after a fracture of the lower leg, persists many years after the fracture. In a long-term follow-up we measured bone mineral density (BMD) b y dual-energy X-ray absorptiometry (DXA) of both hips and the lumbar spine in a group of 11 patients, 5 years after a fracture of the lower leg. These patients were part of an earlier study, evaluating bone loss in the hip, u p to 1 year after fracture of the lower leg. In this follow-up study, 5 yea rs after fracture, loss from baseline BMD in the trochanteric region of the ipsilateral hip was 4.7% (p = 0.04), whereas after a year in this group th ere was a decrease of 12.5% from baseline. On the contralateral side, hardl y any change occurred. In the ipsilateral femoral neck, 5 years after fract ure, BMD decreased by 2.9% (p = 0.10), after 1 year loss from baseline was 5.1%. In a cross-sectional study we examined the differences in BMD of both hips, measured by DXA, in a group of 19 elderly patients reporting a fract ure of the lower leg, with a mean time of 9.3 years after fracture, In this study, we found a 4.7% lower BMD in the trochanteric region of the hip on the fractured side compared with the nonfractured side (p = 0.006), and a 2 .9% lower BMD in the femoral neck (p = 0.25). We conclude that, after fract ure of the lower leg, BMD in the ipsilateral hip decreases significantly, w ith maximal bone loss after 1 year. After 5 years recovery has occurred, bu t not to baseline. Thereafter, significant excess bone loss is still observ ed in the trochanteric region. This persisting lower BMD may lead to an inc reased risk of another fracture in later years, (Bone 24:131-134; 1999) (C) 1999 by Elsevier Science Inc. All rights reserved.