Fragility Fracture Identifies Patients at Imminent Risk for Subsequent Fracture: Real-world Retrospective Database Study in Ontario, Canada

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2021 Feb 27

PMID 33637078

Citations 24

Authors

Jonathan D Adachi

Jacques P Brown

Emil Schemitsch

Jean-Eric Tarride

Vivien Brown

Alan D Bell

Maureen Reiner

Millicent Packalen

Ponda Motsepe-Ditshego

Natasha Burke

Lubomira Slatkovska

Affiliations

Soon will be listed here.

Abstract

Background: The secondary fracture prevention gap in the osteoporosis field has been previously described as a 'crisis'. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1-2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures.

Methods: This retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized.

Results: Among 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236-955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture.

Conclusions: This cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated.

Citing Articles

Cost-effectiveness analysis of romosozumab for severe postmenopausal osteoporosis at very high risk of fracture in Mexico.

Diaz Martinez J, Aubry de Maraumont T, Natty Sanchez E, Camacho Cordero L, Yeh E PLoS One. 2025; 20(2):e0299673.

PMID: 39919094 PMC: 11805434. DOI: 10.1371/journal.pone.0299673.

First fracture in rheumatoid arthritis: analysis by fracture site, gender, age, and comorbidities.

Taylor-Williams O, Keen H, Preen D, Nossent J, Inderjeeth C Osteoporos Int. 2024; 36(1):113-121.

PMID: 39532717 DOI: 10.1007/s00198-024-07311-1.

Risk of Subsequent Hip Fractures across Varying Treatment Patterns for Index Vertebral Compression Fractures.

Ton A, Bell J, Karakash W, Alter T, Erdman M, Kang H J Clin Med. 2024; 13(16).

PMID: 39200923 PMC: 11355522. DOI: 10.3390/jcm13164781.

The predictive value of albumin to alkaline phosphatase ratio for vertebral refractures in postmenopausal women.

Zhang S, Pan W, Yang J, Ren C, Ge X, Fang X J Bone Miner Metab. 2024; 42(5):600-607.

PMID: 39069602 DOI: 10.1007/s00774-024-01525-3.

Fracture liaison service-a multidisciplinary approach to osteoporosis management.

Le H, Van B, Shahzad H, Teng P, Punatar N, Agrawal G Osteoporos Int. 2024; 35(10):1719-1727.

PMID: 39020092 PMC: 11427598. DOI: 10.1007/s00198-024-07181-7.

References

Wang P, Li Y, Zhuang H, Yu H, Cai S, Xu H . Influence of bone densitometry on the anti-osteoporosis treatment after fragility hip fracture. Aging Clin Exp Res. 2018; 31(10):1525-1529. PMC: 6763573. DOI: 10.1007/s40520-018-1094-7. View

Jin Y, Lee J, Xu B, Cho M . Effect of medications on prevention of secondary osteoporotic vertebral compression fracture, non-vertebral fracture, and discontinuation due to adverse events: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2019; 20(1):399. PMC: 6717630. DOI: 10.1186/s12891-019-2769-8. View

Austin P, Tu J, Ko D, Alter D . Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction. CMAJ. 2008; 179(9):901-8. PMC: 2565714. DOI: 10.1503/cmaj.080295. View

Beaudoin C, Jean S, Moore L, Gamache P, Bessette L, Ste-Marie L . Number, Location, and Time Since Prior Fracture as Predictors of Future Fracture in the Elderly From the General Population. J Bone Miner Res. 2018; 33(11):1956-1966. DOI: 10.1002/jbmr.3526. View

Benchimol E, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I . The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015; 12(10):e1001885. PMC: 4595218. DOI: 10.1371/journal.pmed.1001885. View

Papaioannou A, Kennedy C, Ioannidis G, Gao Y, Sawka A, Goltzman D . The osteoporosis care gap in men with fragility fractures: the Canadian Multicentre Osteoporosis Study. Osteoporos Int. 2007; 19(4):581-7. PMC: 5104547. DOI: 10.1007/s00198-007-0483-0. View

Clinton J, Franta A, Polissar N, Neradilek B, Mounce D, Fink H . Proximal humeral fracture as a risk factor for subsequent hip fractures. J Bone Joint Surg Am. 2009; 91(3):503-11. PMC: 2669747. DOI: 10.2106/JBJS.G.01529. View

Maravic M, Briot K, Roux C . Burden of proximal humerus fractures in the French National Hospital Database. Orthop Traumatol Surg Res. 2014; 100(8):931-4. DOI: 10.1016/j.otsr.2014.09.017. View

Bessette L, Ste-Marie L, Jean S, Davison K, Beaulieu M, Baranci M . The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int. 2007; 19(1):79-86. DOI: 10.1007/s00198-007-0426-9. View

10.

Bauer D . Osteoporosis Treatment After Hip Fracture: Bad News and Getting Worse. JAMA Netw Open. 2019; 1(3):e180844. DOI: 10.1001/jamanetworkopen.2018.0844. View

11.

van Geel T, van Helden S, Geusens P, Winkens B, Dinant G . Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis. 2008; 68(1):99-102. DOI: 10.1136/ard.2008.092775. View

12.

Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle S, Grauer A . Risk of subsequent fracture after prior fracture among older women. Osteoporos Int. 2018; 30(1):79-92. PMC: 6332293. DOI: 10.1007/s00198-018-4732-1. View

13.

Dreinhofer K, Mitchell P, Begue T, Cooper C, Costa M, Falaschi P . A global call to action to improve the care of people with fragility fractures. Injury. 2018; 49(8):1393-1397. DOI: 10.1016/j.injury.2018.06.032. View

14.

Johansson H, Siggeirsdottir K, Harvey N, Oden A, Gudnason V, McCloskey E . Imminent risk of fracture after fracture. Osteoporos Int. 2016; 28(3):775-780. PMC: 5338733. DOI: 10.1007/s00198-016-3868-0. View

15.

Bell A, Hill M, Herman R, Girard M, Cohen E . Management of atherothrombotic risk factors in high-risk Canadian outpatients. Can J Cardiol. 2009; 25(6):345-51. PMC: 2722477. DOI: 10.1016/s0828-282x(09)70088-1. View

16.

Ioannidis G, Papaioannou A, Hopman W, Akhtar-Danesh N, Anastassiades T, Pickard L . Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ. 2009; 181(5):265-71. PMC: 2734204. DOI: 10.1503/cmaj.081720. View

17.

Schousboe J, Fink H, Taylor B, Stone K, Hillier T, Nevitt M . Association between self-reported prior wrist fractures and risk of subsequent hip and radiographic vertebral fractures in older women: a prospective study. J Bone Miner Res. 2004; 20(1):100-6. DOI: 10.1359/JBMR.041025. View

18.

Roux C, Briot K . The crisis of inadequate treatment in osteoporosis. Lancet Rheumatol. 2024; 2(2):e110-e119. DOI: 10.1016/S2665-9913(19)30136-5. View

19.

Giangregorio L, Leslie W . Time since prior fracture is a risk modifier for 10-year osteoporotic fractures. J Bone Miner Res. 2010; 25(6):1400-5. DOI: 10.1002/jbmr.35. View

20.

Kanis J, Harvey N, McCloskey E, Bruyere O, Veronese N, Lorentzon M . Algorithm for the management of patients at low, high and very high risk of osteoporotic fractures. Osteoporos Int. 2019; 31(1):1-12. PMC: 7018677. DOI: 10.1007/s00198-019-05176-3. View