Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

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.

Hip fracture predicts subsequent hip fracture: a retrospective observational study to support a call to early hip fracture prevention efforts in post-fracture patients

“…The most common comorbidities in this cohort were osteoarthritis (76.2%, n = 88,223), diabetes (30.6%, n = 35,434) and stroke or cerebrovascular events (30.3%, n = 35,030). The proportion of patients on any osteoporosis treatment 1 year prior to index fracture was 28.3% ( n = 32,757), as further described in a recent report on the same fracture cohort [ 35 ]. A hip fracture was the most common index fracture, occurring in 27.3% ( n = 31,613) of patients (Table 1 ).…”

“…However, the risk of second hip fracture was consistently ≥ 19% over a median time of < 2 years across index fracture sites. Considering a 3% 10-year hip fracture risk is a high-risk threshold recommended by clinical practice guidelines [ 18 ], this is an important finding informing hip fracture prevention efforts to focus on all osteoporotic-related fracture sites as part of secondary hip fracture prevention [ 35 ]. Patients with an index hip fracture also accounted for the most deaths, surgeries and post-surgery complications within the first year post-fracture, and 1-year mortality rate after index hip fracture was the highest amongst all fracture sites examined.…”

Definition and management of very high fracture risk in women with postmenopausal osteoporosis: a position statement from the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Association of Bone Assessment and Metabolism (ABRASSO)

“…Virtually all types of fragility fractures, including fractures in nonvertebral sites such as wrist and humerus, are followed by imminent fracture risk (25)(26)(27), but the magnitude of the risk of refracture varies by the location of the previous fracture (Table 2). In three recent large cohorts of patients with an incident fracture, the incidence of subsequent fractures within 1-2 years was highest in those with an index vertebral fracture (28)(29)(30). Patients with an index wrist fracture had lower absolute risk relative to those with index fracture occurring at most of the other skeletal sites (29).…”

Fragility fracture systems, Latin America perspective

“…[35] Compared to the general population, a woman with a hip, vertebral, or proximal humeral fracture has a 2-to 18-fold increased risk of a new fracture. [36] As in other regions, Argentina has a significant percentage of patients who, after suffering a fracture, do not receive any type of treatment or do not adhere to it. This problem, in the secondary prevention of fragility fractures, was identified by the IOF and the American Society for Bone and Mineral Research that proposed FLS programs.…”