Effects of osteoporosis on AIS 3+ injury risk in motor-vehicle crashes.

Older occupants in motor-vehicle crashes are more likely to experience injury than younger occupants. One possible reason for this is that increasing age is associated with increased prevalence of osteoporosis, which decreases bone strength. Crash-injury data were used with Bayes' Theorem to estimate the conditional probability of AIS 3+ skeletal injury given that an occupant is osteoporotic for the injury to the head, spine, thorax, lower extremities, and upper extremities. This requires the conditional probabilities of osteoporosis given AIS 3+ injury for each of the body regions, which were determined from analysis of the Crash Injury Research and Engineering Network database. It also requires information on probability of osteoporosis in the crash-involved population and the probabilities of AIS 3+ skeletal injury to different body regions in crashes. The latter probabilities were obtained from the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) database. The former was obtained by modeling the probability of osteoporosis in the US populations using data from the 2006 National Health Examination Nutrition Survey and applying this model to the estimate of the crash-involved population in NASS-CDS. To attempt to account for the effects of age on injury outcome that are independent of osteoporosis, only data from occupants who were 60 years of age or older were used in all analyses. Results indicate that the only body region that experiences a statistically significant change in fracture injury risk with osteoporosis is the spine, for which osteoporosis increases the risk of AIS 3+ fracture by 3.28 times, or from 0.41% to 1.34% (p<0.0001). This finding suggests that the increase in AIS 3+ injury risk with age for non-spine injuries is likely influenced by factors other than osteoporosis.