Osteoporotic fractures are common dealing in our orthopaedic clinics and trauma rooms. I want to know that is there a large incidence of malnourishment present is such patient suffering from osteoporotic fractures?
I don't know what kind of malnourishment you are talking about, but in the case of anorexia-related osteoporosis, there is a with osteoporotic fracture as mentioned in the introduction of "Factors Influencing Changes in Bone Mineral Density in Patients with Anorexia Nervosa-Related Osteoporosis: The Effect of Hormone Replacement Therapy. Legroux-Gerot et al, Calcif Tissue Int (2008) 83:315–323 :
Over the last few years anorexia nervosa (AN) has become a serious public health issue in industrialized countries. AN occurs with a very high frequency among young women (0.5% prevalence as opposed to 2% for bulimia) and gives rise to serious metabolic complications resulting from malnutrition [1, 2]. One of the complications of the disorder is bone loss. Indeed, osteoporosis may occur in 20–50% of cases depending on the groups observed, with bone fracturing occurring in 44% of patients [1–7]. In patients who have had the disorder for an average of 5.8 years, the risk of fractures occurring is seven times higher than in healthy women of the same age [8]. Fractures tend to occurat the most common osteoporotic fracture sites, i.e., most frequently at vertebrae and at the radius and the upper extremity of the femur [3, 9–11].
I hope this will contribute to answer your question.
I think exact factors that determine bone mineral density are poorly understood but studies in twins indicate that the BMD is determined by heredity . Other important factors are environmental factors such as the level of estrogen, testosterone, and growth hormone in addition to the level of exercise and nutrition as well as any diseases that interfere with normal growth. but i don`t know that is there any direct correlation between osteoprosis and protein-energy malnutriyion.
It is evident that dietary deficit in development period has negativy influence for achieving a good bone mass, which facilitates the appearance of osteoporosis and fractures result. In adulthood also has importance insufficient or unbalanced feeding in the appearance of osteoporosis . The malnourishment is one of the risk factors that are valued in the appearance of osteoporotic fractures
The quality of bone, at the age the peak bone mass is achieved, is dependent on vitamin D, K status and calcium metabolism during growing (bone modelling). At menopause osteoporosis is affectig one in three women. In this incidence a major role plays the genetic inheritance (about 70%). The rest of two from three postmenopausal women, who are not affected by osteoporosis, may develop osteopenia in vitamin D and K deficiency (as well nutritional deficiencies), but I do not know any study showing the risk of fracture in osteopenic subjects.
Malnutrition, such as vitamin D and/or calcium deficiency, might also trigger hyperparathyroidism which will eventually cause osteoporosis. Besides factors such as age, sex and genetics, the nutritional quality of diet should be considered.
I agree with Dr. Chauveau and Dr. Herrera that poor supply with calcium rich food can conntribute to osteoporosis by disturbing calcium metabolism. On the other hand,this is the idea of treating osteoporosis with biphosphonaytes,calcium (obligatory) and vitamin D.
As previously said there most be a link, it sound logical than Vit. D and Calcium Deficiency are related, but other factor my have a role to, we made a study about Hip surgery and delay healing in nutritional deficiency using the lymphocyte count(less than 1500) as a parameter, it doesn't need special studies and have been used as marker in other pathologies as Pneumonia risk in Elderly, we found 26 of 48 patient with low lymphocyte count but no difference between traumatic or non traumatic surgery.
As we have seen we can not explain Fracture Risk only with the mineral part of the bone and it appears that proteins of the extra-cellular matrix play an important role, so i Will go for protein Deficiency in firs place.
Hope it serves
This is the link to the article although is in Spanish.
Undernutrition, particularly protein undernutrition, contributes to the occurrence of osteoporotic fracture, by lowering bone mass and altering muscle strength. Furthermore, the rate of medical complications after fracture can also be increased by nutritional deficiency. The IGF-I system appears to be directly involved in the pathogenetic mechanisms leading to osteoporotic hip fracture in elderly and to its complications. In the presence of adequate calcium and vitamin D supplies, protein supplements increasing the intakes from low to normal, raises IGF-I levels, improves the clinical outcome after hip fracture, and attenuates the decrease in proximal femur bone mineral density in the year following the fracture. This nutritional approach is associated with a significant reduction of the stay in rehabilitation hospital. This underlines the importance of nutritional supports in preventing and healing osteoporotic fractures.