Yes We Can! Reducing the Burden of Proximal Humerus Fractures

Introduction The American Orthopaedic Association (AOA) Own The Bone (OTB) registry was utilized to evaluate patients with proximal humerus fractures (PHF) to determine (a) previous fragility fractures, (b) prior treatment for osteoporosis and (c) concurrent fractures to determine risk factors. Methods Between 2009-2023, data was entered in a HIPAA-compliant registry. Inclusion criteria were age 50 and older and a low-energy fracture. Demographic data was extracted. The data set was filtered for humeral fractures and associations run with history of fractures, medications, gender, BMI, postmenopausal status, and Dexa scores using chi-square statistic, t-tests, and ANOVA. Results There were 76,890 patients; 1388 had a primary PHF. 76% (835) were postmenopausal women. BMI data was evenly distributed. 303 (22%) patients experienced a concurrent fracture. Prior fractures occurred in 298 patients (21%). 384 (35%) had a history of Vitamin D deficiency. 40% were on calcium supplements, and 47% were taking Vitamin D at the time of fracture or in the past. 19% of PHF patients completed BMD testing. 83 (6%) of PHF patients consumed 3+ drinks daily (p < 0.001), and 118 (9%) were smokers (p = 0.002). 305 (22%) of PHF patients had been on PPIs, and 167 (12%) had been on SSRIs. 275 (20%) patients had 2 or more falls in the preceding year. Discussion The majority of PHF occurred in postmenopausal females, and 21% had prior fractures. Some patients were supplemented with Vitamin D and calcium, and only 19% had BMD testing indicating areas of improvement. The history of prior falls was 20%, and this should be recognized as a risk factor. The association between patients taking PPIs and SSRIs cannot be overlooked. This study identified premorbid factors that are associated with a PHF and can serve as a form of prevention for subsequent fragility fractures.