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Previous fracture, low BMI, fall history predict imminent fracture risk
Older adults with BMI 20 kg/m² or less who have a history of falling and have sustained a low-trauma, nonvertebral fracture are more likely to sustain another fracture in the following 3 years than patients without previous fracture history, according to findings from researchers in France.
Karine Briot, MD, PhD, of the department of rheumatology at Paris Descartes University, France, and colleagues analyzed data from 950 patients included in the Fracture Liaison Service of Cochin Hospital, which provides assessment for osteoporosis to all in-hospital patients admitted for low-trauma nonvertebral fracture, between February 2009 and October 2016 (84% women; mean age, 75 years; mean femoral neck T score, –2.3). Researchers assessed location and date of previous vertebral and nonvertebral fractures that occurred before the index fracture, as well as variables collected in the 4 to 90 days after the index fracture, including FRAX data and bone mineral density measured at the lumbar spine and total hip. Researchers stratified the cohort by time between the index fracture and the most recent prevalent fracture (patients with prevalent low-trauma, nonvertebral fractures occurring less than 3 years before index fracture and others).
Fractures leading to inclusion in the Fracture Liaison Service were hip (49%), wrist (15%), humerus (11%), ankle (6%) and vertebrae (3.8%). Within the cohort, 341 patients (36%) had a history of low-trauma, nonvertebral fractures; 133 (14%) within the 3 years preceding the index fracture (on average, 1.5 years before).
Researchers found that the risk for inclusion in the Fracture Liaison Service with a previous fracture less than 3 years before was associated with a history of fall in the year before the admission (OR = 2.75; CI 95% 1.55-4.93); history of severe, low-trauma nonvertebral fracture (OR = 2.54; CI 95% 1.45-4.52); and BMI lower than 20 kg/m² (OR = 2.45; CI 95% 1.25-4.87). Researchers found that older age of at least 78 years was protective (OR = 0.44; 95% CI, 0.24-0.8).
Only 20% of included patients were receiving an anti-osteoporosis treatment, the researchers noted.
“Our study showed that history of falls and previous severe nonvertebral fractures are the main risk factors of short-term risk of refracture,” the researchers wrote. “These risk factors are quite easy to collect and should help the practitioner in identifying the patients with an elevated short-term risk of recurrent fracture. Neglecting the imminent risk of refracture is a missed opportunity to take appropriate care of osteoporosis. These patients are the ones who should benefit from an anti-osteoporotic treatment and from a multidisciplinary management to prevent falls, with the help of physiotherapists, occupational therapists and geriatricians, if necessary.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.