Background/Purpose: While fractures in both the elderly and pediatric populations have been extensively investigated, comparatively little attention has been given to the age-group in between. Thus, we determined incidence rates for all fractures in young adult residents from a defined geographic population (age range, 18 to 49 years), in 2009-11, and compared the distribution of fracture sites and causes in this young adult cohort with those age ≥50 years old from the same population.

Methods: Using a unique medical records linkage system that allows access to all (inpatient and outpatient) community medical records for the population under study, we identified all fractures that occurred among young adult residents during the 3-year period. All medical records were reviewed by trained nurse abstractors to validate all fractures identified and to determine their antecedent cause (pathological process [e.g., metastatic malignancy], severe trauma [e.g., motor vehicle accidents, falls from greater than standing height] and those due to no more than moderate trauma [by convention, equivalent to a fall from standing height or less]). Comparable results that we previously reported in residents age ≥50 years old (JBMR 2014) were used for comparisons.

Results: During 2009-2011, 2,482 residents age 18-49 years experienced one or more fractures. There were 1,730 fractures among 1,447 men compared to 1,164 among 1,035 women, and the age-adjusted incidence of all fractures was 66% greater among the men (1,882 [95% CI, 1,793-1,971] vs. 1,135 [95% CI, 1,069-1,201] per 100,000 person-years; p<0.001). Of all fractures, 80% resulted from severe trauma compared to 33% in residents age ≥50 years who sustained a fracture in 2009-11. Younger residents (ages 18-49 years) had a greater proportion of fractures than older residents (age ≥50 years) of the hands and feet (40% vs. 18%) with relatively few fractures observed at traditional osteoporotic fracture sites (wrist, shoulder, spine or hip) (14% vs. 43%). Vertebral fractures were still more likely to be due to moderate trauma than at other sites in younger residents, especially in women (57% vs. 32% in men, 26% vs. 72% in women, for severe vs. moderate trauma vertebral fractures, respectively).

Conclusion: In conclusion, whereas elderly populations often fracture from no more than moderate trauma, young adults, and more commonly men, suffer fractures primarily at non-osteoporotic sites due to more significant trauma. The main exception is vertebral fractures in young women, which are still more likely to be secondary to moderate trauma.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/fracture-incidence-and-characteristics-in-young-adults-age-18-to-49-years-a-population-based-study/