Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;6(3):151-159.
doi: 10.1016/j.afos.2020.08.003. Epub 2020 Sep 13.

Is ankle fracture related to low bone mineral density and subsequent fracture? A systematic review

Atiporn Therdyothin  1 , Nacharin Phiphopthatsanee  2 , Wiwat Wajanavisit  1 , Patarawan Woratanarat  1 , Sukij Laohajaroensombat  1 , Tulyapruek Tawonsawatruk  1
Affiliations

Is ankle fracture related to low bone mineral density and subsequent fracture? A systematic review

Atiporn Therdyothin et al. Osteoporos Sarcopenia. 2020 Sep.

Erratum in

Abstract

Objectives: Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD), and to investigate the risk of subsequent fractures after ankle fracture.

Methods: MEDLINE and Scopus publications were searched from inception to March and April 2019, respectively. Articles were selected by 2 independent reviewers for cross-sectional, cohort, or case-control studies comparing BMD or subsequent fracture risk in low-energy ankle fractures patients with that of the normal population. Data extraction was performed by 2 investigators. Discrepancies were resolved with the third reviewer. Quality assessment was conducted using the modified Newcastle-Ottawa Scale.

Results: Overall, 19 articles were included. The quality assessment showed a generally low-to-moderate risk of bias among studies, mainly due to potential confounders and inadequate follow-up. Of 13 studies exploring BMD in ankle fractured-patients, lower central and peripheral BMD was found in 3 and 2 studies, respectively. The risk of subsequent fracture was examined in 11 studies with relative risks ranging from 0.7 to 4.59. An increased risk of any subsequent fractures in women, both genders, and men was found in 5, 2, and 1 articles, respectively.

Conclusions: Despite the lack of clear association with BMD, the contribution of ankle fracture to increased subsequent fracture risk and its associated microarchitectural changes cannot be overlooked. Moreover, its potential role as an early predictor of future fracture may promote secondary prevention. Further studies with longer follow-up and stricter confounder control are recommended.

Keywords: Ankle fracture; Bone mineral density; Fracture prediction; Osteoporosis; Risk factor.

PubMed Disclaimer

Conflict of interest statement

Atiporn Therdyothin: Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Writing - original draft. Nacharin Phiphopthatsanee: Data curation, Resources, Writing - review & editing. Wiwat Wajanavisit: Writing - review & editing. Patarawan Woratanarat: Supervision, Validation. Sukij Laohajaroensombat: Conceptualization. Tulyapruek Tawonsawatruk: Conceptualization, Formal analysis, Investigation, Methodology, Resources, Validation, Supervision, Writing - review & editing.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM. A comprehensive overview on osteoporosis and its risk factors. Therapeut Clin Risk Manag. 2018;14:2029–2049. - PMC - PubMed
    1. Qaseem A, Forciea MA, McLean RM, Denberg TD. Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American college of physicians. Ann Intern Med. 2017;166:818–839. - PubMed
    1. Johnson NA, Stirling ER, Divall P, Thompson JR, Ullah AS, Dias JJ. Risk of hip fracture following a wrist fracture-A meta-analysis. Injury. 2017;48:399–405. - PubMed
    1. Balasubramanian A., Zhang J., Chen L., Wenkert D., Daigle S.G., Grauer A. Risk of subsequent fracture after prior fracture among older women. Osteoporos Int. 2019;30:79–92. - PMC - PubMed
    1. Ettinger B., Ray G.T., Pressman A.R., Gluck O. Limb fractures in elderly men as indicators of subsequent fracture risk. Arch Intern Med. 2003;163:2741–2747. - PubMed