Correlation of bone mineral density with ankle fractures in older adults in Korea: a retrospective cohort study

Background: Bone mineral density (BMD) is well-documented in relation to fractures of the spine, hip, distal radius, and proximal humerus; however, its correlations with other fracture types are less established. This study aimed to analyze BMD and associated risk factors in older adults (≥65 years of age) with osteoporotic ankle fractures. These fractures involve low-energy trauma, resulting from falls from a standing height or lower, and occur from impacts which typically do not cause fractures in individuals with normal bone. Methods: This retrospective study analyzed data from 1,411 patients diagnosed with ankle fractures admitted to Chosun University Hospital between February 2012 and April 2023. After applying inclusion criteria (age ≥65 years; low energy ankle fracture) and exclusion criteria (high energy trauma, open/multiple fractures, missing dual X-ray absorptiometry [DXA]), 73 of 1,411 patients were analyzed. Lumbar spine, femoral neck, and total hip T scores were obtained with a Horizon Wi DXA scanner, and associations with age, sex, mechanism of injury, comorbidities, smoking status, alcohol consumption, body mass index (BMI), and history of fractures were tested by ANOVA with Scheffe post hoc and Fisher exact tests.Results: Lower BMD correlated significantly with older age, female sex, and lower BMI (P<0.05) in older adults with ankle fractures. No significant associations were observed for comorbidities (diabetes, hypertension, dementia), smoking, alcohol consumption, injury mechanism, or prior fractures.Conclusion: These results indicate that older age, female, and lower BMI are linked to reduced BMD in ankle fracture patients over 65 years of age. Focused osteoporosis screening and management may therefore be most beneficial for older, low BMI women presenting with ankle fractures.Level of evidence: IV.