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Published in: Osteoporosis International 7/2022

21-03-2022 | Chronic Inflammatory Bowel Disease | Short Communication

Cluster analysis demonstrates co-existing sites of fragility fracture and associated comorbidities

Authors: M. Dey, M. Bukhari

Published in: Osteoporosis International | Issue 7/2022

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Abstract

Summary

We undertook cluster analysis in 11,003 patients who had sustained ≥ 1 fragility fracture, to find associations between fracture sites and comorbidities. We identified three distinct groups of fracture sites and four clusters of fractures and comorbidities. Knowledge of factors associated with fracture sites will aid prophylaxis in at-risk patients.

Introduction

Fragility fracture (FF) prevalence is increasing. Subsequent fractures lead to greater morbidity and mortality. Few data are available on the association between FF sites and comorbidities.
Objectives:
1.
Establish the most common sites of FF and clusters within patients.
 
2.
Identify patterns of co-existing FF and associated comorbidities.
 

Methods

We retrospectively reviewed clinical records of patients undergoing bone mineral density estimation at a district hospital in North-West England, 2004–2016, identifying those who had sustained ≥ 1 FF. Demographics, FF site(s), comorbidities, and medications were recorded. Cluster analysis was performed on fracture sites alone, and sites and comorbidities, using Jaccard similarity coefficient. Results were plotted on a dendrogram and divided into clusters.

Results

Of 28,868 patients, 11,003 had sustained ≥ 1 FF, 84.6% female, with overall mean age 67.5 years and median T-score − 1.12 SD. FF of the forearm was more frequent (n = 5045), most commonly co-existing with tibia/fibula fractures. Three FF site clusters were identified: ankle and elbow; forearm, tibia/fibula, ribs and spine; and pelvis, femur and humerus. When including comorbidities, four clusters were identified: forearm, tibia/fibula, spine, associated with family history of FF, smoking, corticosteroids and bisphosphonates; pelvis associated with hyperparathyroidism, PMR, coeliac disease and HRT; femur and humerus associated with IBD and RA; and ribs associated with alcohol and hyperthyroidism.

Conclusion

Cluster analysis demonstrated three fracture site clusters, and four subgroups of FF sites and comorbidities. Cluster analysis is a novel method to evaluate comorbidities associated with FF sites. Knowledge of factors associated with FF sites will aid prophylaxis in at-risk patients.
Literature
1.
go back to reference Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2001) The burden of osteoporotic fractures: A method for setting intervention thresholds. Osteoporos Int Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2001) The burden of osteoporotic fractures: A method for setting intervention thresholds. Osteoporos Int
3.
go back to reference Ensrud KE (2013) Epidemiology of fracture risk with advancing age. J Gerontol - Ser A Biol Sci Med Sci Ensrud KE (2013) Epidemiology of fracture risk with advancing age. J Gerontol - Ser A Biol Sci Med Sci
6.
go back to reference Adachi JD, Berger C, Barron R, Weycker D, Anastassiades TP, Davison KS et al (2019) Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos [Internet]. [cited 2021 Dec 22];14(1). Available from: https://pubmed.ncbi.nlm.nih.gov/31098708/ Adachi JD, Berger C, Barron R, Weycker D, Anastassiades TP, Davison KS et al (2019) Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos [Internet]. [cited 2021 Dec 22];14(1). Available from: https://​pubmed.​ncbi.​nlm.​nih.​gov/​31098708/​
8.
go back to reference Hansen L, Petersen KD, Eriksen SA, Langdahl BL, Eiken PA, Brixen K et al (2014) Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int [Internet]. [cited 2021 Dec 22];26(2):513–9. Available from: https://link.springer.com/article/https://doi.org/10.1007/s00198-014-2875-2 Hansen L, Petersen KD, Eriksen SA, Langdahl BL, Eiken PA, Brixen K et al (2014) Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int [Internet]. [cited 2021 Dec 22];26(2):513–9. Available from: https://​link.​springer.​com/​article/​https://​doi.​org/​10.​1007/​s00198-014-2875-2
10.
go back to reference Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE et al (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164(10):1108–1112CrossRef Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE et al (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164(10):1108–1112CrossRef
12.
go back to reference Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A et al (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int [Internet]. [cited 2021 Dec 22];30(1):79. Available from: /pmc/articles/PMC6332293/ Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A et al (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int [Internet]. [cited 2021 Dec 22];30(1):79. Available from: /pmc/articles/PMC6332293/
14.
go back to reference Iconaru L, Moreau M, Kinnard V, Baleanu F, Paesmans M, Karmali R et al (2019) Does the Prediction Accuracy of Osteoporotic Fractures by BMD and Clinical Risk Factors Vary With Fracture Site? JBMR Plus [Internet]. [cited 2021 Dec 22];3(12). Available from: /pmc/articles/PMC6894722/ Iconaru L, Moreau M, Kinnard V, Baleanu F, Paesmans M, Karmali R et al (2019) Does the Prediction Accuracy of Osteoporotic Fractures by BMD and Clinical Risk Factors Vary With Fracture Site? JBMR Plus [Internet]. [cited 2021 Dec 22];3(12). Available from: /pmc/articles/PMC6894722/
15.
go back to reference Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O et al (2019) Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int [Internet]. [cited 2021 Dec 22];30(3):601. Available from: /pmc/articles/PMC6422949/ Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O et al (2019) Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int [Internet]. [cited 2021 Dec 22];30(3):601. Available from: /pmc/articles/PMC6422949/
16.
go back to reference Söreskog E, Ström O, Spångéus A, Åkesson KE, Borgström F, Banefelt J et al (2020) Risk of major osteoporotic fracture after first, second and third fracture in Swedish women aged 50 years and older. Bone [Internet]. [cited 2021 Dec 22];134. Available from: https://pubmed.ncbi.nlm.nih.gov/32070789/ Söreskog E, Ström O, Spångéus A, Åkesson KE, Borgström F, Banefelt J et al (2020) Risk of major osteoporotic fracture after first, second and third fracture in Swedish women aged 50 years and older. Bone [Internet]. [cited 2021 Dec 22];134. Available from: https://​pubmed.​ncbi.​nlm.​nih.​gov/​32070789/​
17.
go back to reference Morin SN, Yan L, Lix LM, Leslie WD (2021) Long-term risk of subsequent major osteoporotic fracture and hip fracture in men and women: a population-based observational study with a 25-year follow-up. Osteoporos Int [Internet]. [cited 2021 Dec 22];32(12):2525–32. Available from: https://pubmed.ncbi.nlm.nih.gov/34165587/ Morin SN, Yan L, Lix LM, Leslie WD (2021) Long-term risk of subsequent major osteoporotic fracture and hip fracture in men and women: a population-based observational study with a 25-year follow-up. Osteoporos Int [Internet]. [cited 2021 Dec 22];32(12):2525–32. Available from: https://​pubmed.​ncbi.​nlm.​nih.​gov/​34165587/​
18.
go back to reference Holm JP, Hyldstrup L, Jensen JEB (2016) Time trends in osteoporosis risk factor profiles: a comparative analysis of risk factors, comorbidities, and medications over twelve years. Endocrine [Internet]. [cited 2021 Dec 22];54(1):241–55. Available from: https://pubmed.ncbi.nlm.nih.gov/27178283/ Holm JP, Hyldstrup L, Jensen JEB (2016) Time trends in osteoporosis risk factor profiles: a comparative analysis of risk factors, comorbidities, and medications over twelve years. Endocrine [Internet]. [cited 2021 Dec 22];54(1):241–55. Available from: https://​pubmed.​ncbi.​nlm.​nih.​gov/​27178283/​
19.
go back to reference Sale JEM, Frankel L, Bogoch E, Gignac M, Hawker G, Elliot-Gibson V, et al (2020) Few fragility fracture patients perceive that their bone health is affected by their comorbidities and medications. Osteoporos Int [Internet]. [cited 2021 Dec 22];31(10):2047–55. Available from: https://pubmed.ncbi.nlm.nih.gov/32504095/ Sale JEM, Frankel L, Bogoch E, Gignac M, Hawker G, Elliot-Gibson V, et al (2020) Few fragility fracture patients perceive that their bone health is affected by their comorbidities and medications. Osteoporos Int [Internet]. [cited 2021 Dec 22];31(10):2047–55. Available from: https://​pubmed.​ncbi.​nlm.​nih.​gov/​32504095/​
Metadata
Title
Cluster analysis demonstrates co-existing sites of fragility fracture and associated comorbidities
Authors
M. Dey
M. Bukhari
Publication date
21-03-2022

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