Fragility fractures in France: epidemiology, characteristics and quality of life (the EPIFRACT study)

Cortet, Bernard; Chauvin, Pierre; Féron, Jean-Marc; Grange, Laurent; Coulomb, Alain; Launois, R; Alliot-Launois, Françoise; Sellami, Rahma; Touboul, Chantal; Benoît, Vincent; Joubert, Jean-Michel; Briot, Karine

doi:10.1007/s11657-019-0674-2

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…A further 5% of patients with fractures were excluded because they were not insured continuously. However, there is no reason to think that the findings cannot be generalized to the entire French population, because in general population studies, osteoporotic fracture incidence in France has not been shown to differ according to professional status, ( 54,55 ) although it cannot be excluded that outcomes may differ somewhat.…”

Section: Discussionmentioning

confidence: 99%

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

et al. 2021

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Severe osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

et al. 2021

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“…The differences may be due to the fact that our exclusion criteria prevented the participation of men with recent osteoporotic fractures causing sudden, sharp, and strong pain. Osteoporosis is a generalized skeletal disease that increases the risk of bone fractures causing chronic pain and reducing physical fitness [ 34 , 35 , 36 ]. Ostrowska et al [ 37 ] observed that in many patients, these symptoms are associated with psycho-social discomfort eroding their quality of life.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Quality of Life and Pain Severity in Older Men with Osteoporosis: Cross-Sectional Study

Nawrat–Szołtysik

Miodońska

Piejko

et al. 2021

IJERPH

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Background: The quality of life in osteoporosis is studied for men rather than for women. Aim of the study was to determine how bone mass density (BMD) relates to life quality components and the severity of pain felt by men affected by osteoporosis. Methods: Presented research is a cross-sectional study. The cohort of 62 men aged 65 to 85 years was divided into a group with osteoporosis (N = 27) and a group without osteoporosis (N = 35). The participants’ quality of life was measured with the Qualeffo41 Questionnaire, BMD was quantified by densitometry, and pain intensity was assessed on the Visual Analogue Scale. Results: We found that lower BMD was strongly correlated to participants’ quality of life (r = −0.72), especially the quality of leisure and social activities (r = −0.66), general health perception (r = −0.59), and mobility (r = −0.57). Pain significantly affected general health perception in older men with osteoporosis. General health assessment and pain were highly correlated with each other (r = 0.888). Conclusion: BMD and the overall quality of life of the study participants were related to each other. The strongest relationship occurred between reduced BMD and leisure and social activities component. The pain significantly affected participants’ general health perception. The results may be employed to create new prophylactic strategies to improve life quality in men with osteoporosis.

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“…The low numbers of patients experiencing fractures to whom densitometry is offered and treatments prescribed has been a consistent finding of studies in France for the last 20 years. ( 21 , 22 ) The reason for this possibly lies in the segmentation of care in France, such that when a patient is discharged from hospital after a fracture, there is little communication between the orthopedic surgery department and the general practitioner, who is responsible for prescribing densitometry and osteoporosis treatments. ( 23 ) Establishment of more Fracture Liaison Services in France (there are currently only 30) for osteoporosis care, which have been shown to be a cost‐effective way to reduce refracture rates and their associated expenditure in other countries such as the United Kingdom, ( 24 , 25 ) may help improve this situation.…”

Section: Discussionmentioning

confidence: 99%

The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

Thomas

Tubach

Bizouard

et al. 2020

Journal of Bone and Mineral Research

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Osteoporosis carries a high medical, economic, and societal burden principally because of the risk of severe fractures. The objective of this cost-of-illness study was to describe health resource utilization and associated costs in all patients aged ≥50 years hospitalized for a severe osteoporotic fracture over a 6-year period (2009 to 2014) in France. Data were extracted from the French national healthcare database (SNDS) on all health care resource utilization between the index date (date of hospitalization for first fracture during the enrollment period) and study end (December 31, 2016) or until the patient died. Costing was restricted to direct costs and determined from the payer perspective. Variables related to costs were identified through multivariate logistic regression analysis. A total of 356,895 patients were included (median follow-up 39.1 months). In the year after the index fracture, 36,622 patients (10.5%) were rehospitalized for a fracture-related reason. Only 18,474 (5.3%) underwent bone densitometry and 58,220 (16.7%) received a specific treatment. The total annual per capita osteoporosis-related cost in the year after the index severe osteoporotic fracture was €18,040 (from €8598 for multiple ribs to €21,085 for hip fracture) of which €17,905 was incurred by fracture-related costs. The cost incurred by management of osteoporosis was €135. Over years 2 to 5, the mean annual per capita costs of fracture treatment (€806, mostly attributable to the treatment of refractures) continued to dominate those of osteoporosis management (€99). Total annual cost of care was €1260 million (year 2014). Variables associated with higher cost were older age, male sex, site of fracture, a history of prior osteoporotic fracture, and the number of refracture events. The 5-year cost of severe osteoporotic fractures to the French health care system is high and mostly attributable to the treatment of refractures. Improved fracture prevention measures in patients with osteoporosis is crucial to reduce the economic burden of the disease.

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Fragility fractures in France: epidemiology, characteristics and quality of life (the EPIFRACT study)

Cited by 11 publications

References 26 publications

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

Assessment of Quality of Life and Pain Severity in Older Men with Osteoporosis: Cross-Sectional Study

The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

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