High comorbidity burden among men with subsequent osteoporotic fractures
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Key takeaways :
- Among men with an initial fracture, 12.7% refractured within the first year and 16.7% within the second year.
- Most men who refractured had CVD, hypertension, diabetes, fall history or impaired mobility.
SEATTLE — Among men aged at least 40 years who experienced a fracture, most with subsequent fractures in the next 2 years had cardiometabolic comorbidities and used medications linked to increased fall risk, according to researchers.
“The recognition of associated risk factors can help identify individuals at high risk for subsequent fracture,” Ruban Dhaliwal, MD, MPH, associate professor of medicine in endocrinology, diabetes and metabolism, and director of the Metabolic Bone Disease Center at the State University of New York Upstate Medical University, and a research physician at Massachusetts General Hospital, told Healio. “The study team sought to facilitate recognition of such associated risk factors in men by characterizing a real-world cohort of patients with a prior fracture who experienced a subsequent fracture.”
In this observational study, Dhaliwal and colleagues used anonymized patient-level data from Symphony Health PatientSource to identify men aged 40 years or older with a fracture any time between September 2011 to May 2022. Patients had no prior evidence of cancer except for nonmelanoma skin cancer. Researchers then identified comorbidities and medications associated with an increased risk for falls or fractures as well as patients with the potential to compromise bone quality healing.
Overall, 12.7% (n = 292,421) of patients had refractured within the first year after the index fracture and 16.7% (n = 338,386) within the second year. Of those with a subsequent fracture 52% (n = 153,038) were aged at least 65 years.
Those with a second fracture experienced comorbidities or were taking medications associated with an increased fall risk. Among those with commercial insurance, 39.2% had Parkinson’s disease, 38.3% had dementia, 36.2% had Alzheimer’s disease, 27.8% had muscle weakness/atrophy and 27.2% had a prior stroke. Researchers observed comparable results among patients who were Medicare Advantage enrollees.
One-third of patients with subsequent fractures used oral corticosteroids and almost three-quarters had at least one prescription for opioids.
Among patients who refractured, more than 75% had CVD, more than 64% had hypertension, more than 30% had diabetes, more than 31% had a history of falls, and more than 29% had impaired mobility.
According to Dhaliwal, there is a need for increased awareness among health care providers to recognize fragility fractures in men as an opportunity to assess bone mineral density and implement secondary prevention measures.
“Further research is needed to enhance risk assessment of high-risk patients to inform systematic evaluation, future guidelines and the design of intervention trials,” Dhaliwal said. “Studies should focus on the selection of appropriate candidates for pharmacological treatment and the determination of absolute benefit of pharmacological treatment in men with multiple comorbidities or reduced mobility. These studies are needed in several subgroups of patients to reduce skeletal health disparities.”
For more information:
Ruban Dhaliwal, MD, can be reached at rdhaliwal2@mgh.harvard.edu.
Perspective
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E. Michael Lewiecki, MD, FACE, FACP
Men are like Rodney Dangerfield when it comes to osteoporosis: They “don’t get no respect.”
A substantial portion of patients with osteoporotic fractures are men. Men have higher morbidity and mortality after a fracture than women of the same age. Despite the availability of treatments to reduce fracture risk in men, the treatment gap for men is even worse than it is for women. The risk of a fracture is very high in the first 1 to 2 years following an index fracture. This very large claims-based study of subsequent fractures in men with an index fracture adds to our knowledge of comorbidities that contribute to this risk. It informs us that the risk of a subsequent fracture is notably higher in men with a range of comorbidities, especially cardiovascular diseases and disorders that increase the risk forfalls.
How should this influence our care of men with fractures? It tells me that they should be evaluated soon after having a fracture for all factors that might contribute to the risk for subsequent fractures. In most cases, pharmacological agents to reduce fracture risk should be started soon after the index fracture. Particular attention should be directed to assessing the risk of falls, with appropriate interventions to reduce that risk.
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Dhaliwal R, et al. Abstract #1407491. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 4-6, 2023; Seattle.
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