Actaorthop. scand. 51,205-207,1980

FRACTURE INCIDENCE AND DIAGNOSTIC ROENTGEN IN ALCOHOLICS

HANS KRISTENSSON, ANN LUNDEN & Bo E. NILSSON

Departments of Alcoholic Diseases, Diagnostic Radiology and Orthopedic Surgery, Malmo General Hospital (University of Lund), Malmo, Sweden.

The records of 107 chronic alcoholics were researched for the number of roentgen diagnostic procedures undertaken during the last few decades. It was demonstrated that fractures were about four times as common in alcoholics as in a series of age-matched random controls but there was the same proportion of fractures indicating bone fragility. Skull roentgen ex- aminations and gastro-duodenal examinations were also common. Alcoholics seem to require almost twice the amount of roentgen diagnostic work as the population in general.

Key words: alcoholism; fracture; roentgen

Accepted 3O.vii.79 I t has been demonstrated in the past that alcoholism is one of the factors contributing to injuries such as fracture of the upper end of the femur and fracture of the upper end of the humerus (Nilsson 1970, Horak & Nilsson 1975). It has also been demonstrated that a prolonged misuse of alcohol is related to a decreased bone mineral content (Saville 1967, Nilsson & Westlin 1973). However, alcohol intoxication seems to be a common con- tributing factor t o a variety of traumatic injuries, particularly leisure t ime injuries (Honkanen & Visuri 1976).

T h e purpose of the present investigation w a s t o examine the risk of injuries over an extended period of t ime in a group of in- dividuals who had been classified a s alcoholics.

P A T I E N T S

During the years 1974-1977, a total of 776 men over the age of 50 were registered at the Depart-

ment of Alcoholic Diseases, Malmo General Hospital. Of these 326 were drawn at random and their journals studied. Finally 107 men, aged 61 t 8, were selected who fulfilled the following criteria:

a) Residents of the city of Malmo. b) Sufficient information available, several

visits. c) Qualified without any doubt for the

diagnosis of chronic alcoholism or as alcohol addicts with at least one medical complication such as pancreatitis or liver dysfunction.

The duration of the pathological drinking habits for this group was difficult to establish with any precision but amounted in most instances to decades. For each of the 107 alcoholics two age-matched

men were selected at random from the population record of residents of the city of Malmo, thus providing 214 control men with an age distribu- tion identical with that of the alcoholics.

The Record Room of the Diagnostic Radiology Department contains all referrals and reports of roentgen examinations from 1950 up to the present time. Since about 90 per cent of all planned and more than 95 per cent of all emergency roentgen examinations in the city take place in the Department a fairly accurate

Financial support was obtained from the Swedish Medical Research Council (project no. B78-17X-2737-10C) and the Greta and Johan Kock, and Alfred Osterlund Foundations.

0001-6470/80/020205-03$02.50/0 C 1980 Munkseaard, Copenhagen

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206 H. KRISTENSSON, A. LUNDEN & B. E. NILSSON

representation is obtained. At the time when the records were searched for information about the alcoholics and their controls there was a 28-year roentgen history of the residents of the city available for study. The files were searched for records of roentgen examinations in the same manner for all 321 men involved in the study. Altogether 3242 roentgen referrals were scrutiniz- ed. The following variables were recorded:

a) The total number of fractures over the years. b) The number of fragility fractures-vertebral

crush fracture, fracture of the upper end of the femur, fracture of the upper end of the humerus, fracture of the distal end of the forearm, ankle fracture and fracture of the lateral tibia condyle (Nilsson & Westlin 1977).

c) The total number of skull roentgen ex- aminations and the number of skull fractures.

d) The total number of fractures occurring in conjuction with industrial accidents and traffic accidents.

e) Gastro-duodenal roentgen examinations, total number of “first” examinations excluding all follow-up examinations related to ulcer. Also, the number of the gastro-duodenal peptic ulcers diagnosed over the years.

r) The number of i.v. urographies, again only “first” urographies and not serial investigations, and the number of kidney stones diagnosed over the years.

RESULTS

The average number of roentgen ex- aminations was 14 for alcoholics and 8 for the controls. The number of fractures (Table 1) was almost quadrupled in the alcoholics compared with the controls and so was the number of fragility fractures. The difference was in both instances significant ( P < 0.001’)). The number of skull roentgen examinations, again, was significantly increased ( P < 0.001) -by a factor of more than +in the alcoholics but the large number of roentgen examinations did not reveal an increased number of skull fractures. The number of industrial accident related factures was not significantly increased in the alcoholics. The number of traffic accidents, however, was increased ( P < 0.001) but in relation to the total number of fractures, the traffic accident fractures were not significantly more common in the

I ) Chi-square test.

Table 1 . Radiographic examinations and findings in 100 alcoholics and age-matched controls

Alcoholics Controls

Total fractures Fragility fractures Skull roentgen Skull fractures Industrial accident fractures Traffic accident fractures Gastro-duodenal roentgen Gastro-duodenal ulcer I. v. urography Kidney stones

95 41 69

3

11

13

147

32 50 10

25 11 15 2

7

2

104

20 61 15

alcoholics. The number of gastro-duodenal roentgen examinations and gastro-duodenal ulcers was increased by about half in the alcoholics as compared with the controls-the proportion of positive and negative roent- gen examinations was about the same in both groups. Finally, i.v. urography with or without a positive finding of stones did not differ significantly between alcoholics and controls.

DISCUSSION

Misusers of alcohol are an important-next to the elderly perhaps the most im- portant-group of medical consumers. This consumption of medical care also includes roentgen diagnosis to an extent far above the average. The diagnostic procedures are not always fruitful; skull roentgen examinations as shown above yield very little information but are nevertheless frequently used in the differential diagnosis of intoxication and post- traumatic neurologic conditions. For other fracture examinations, however, the rate of negatives was less in the alcoholics than in the controls. For some diagnostic procedures, such as gastro-duodenal roentgen examina- tion, the proportion of alcoholics having this examination is moderate and easily explained by an increased prevalence of gastric con- ditions. With regard to other common

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FRACTURES AND X-RAY EXAMINATIONS IN ALCOHOLICS 207

diagnostic procedures such as i.v. urography alcoholism seems to be without importance.

REFERENCES

The most striking finding in this study is, no doubt, the increased rate of fracture. However, in spite of the known relationship between alcoholism and fragility fractures in the elderly, as demonstrated in the case of fracture of the neck of the femur and fracture of the upper end of the humerus (Nilsson 1970, Horak & Nilsson 1975), the number of fragility fractures amounted to the same portion of the total in the alcholics as in the controls. This is probably explained by the fact that the alcoholics during most of the period covered by the study had not yet attained the age when fragility fractures become a serious problem.

Honkanen, R. & Visuri, T. (1976) Blood alcohol levels in a series of injured patients with special reference to accident and type of injury. Ann. Chir. Gynaec. Fenn. 65, 287.

Horak, J. & Nilsson, B. E. (1975) Epidemiology of fracture of the upper end of the humerus. Cfin. Orthop. 112, 250.

Nilsson, B. E. (1970) Conditions contributing to fracture of the femoral neck. Acta chir. scand. 136, 383.

Nilsson, B. E. & Westlin, N. E. (1973) Changes in bone mass in alcoholics. Cfin. Orthop. 90, 229.

Nilsson, B. E. & Westlin, N. E. (1977) Bone mineral content and fragility fractures. Cfin. Orthop. 125, 196.

Saville, P. D. (1967) Changes in bone mass with age and alcoholism. J. Bone Jt Surg. 37, 492.

Correspondence to: Bo Nilsson, M. D., Department of Orthopedic Surgery, Malmo General Hospital, S-214 01 Malmo, Sweden.

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