Top

Published in:

Open Access 01-02-2018 | Original Article

Comorbidities and medication use in patients with a recent clinical fracture at the Fracture Liaison Service

Authors: L. Vranken, C. E. Wyers, R. Y. Van der Velde, H. M. Janzing, S. Kaarsemaker, P. P. Geusens, J. P. Van den Bergh

Published in: Osteoporosis International | Issue 2/2018

Abstract

Summary

In this cross-sectional study, two-thirds of Fracture Liaison Service (FLS) patients had comorbidities and medications associated with increased bone- or fall-related fracture risk. Bone-related and fall-related fracture risk (BRR and FRR) were associated with age and fracture type, but not with gender or BMD. Systematic evaluation of these factors leads to a more profound assessment in FLS care.

Introduction

This study is a systematic evaluation of comorbidities and medications associated with increased fracture risk in patients aged 50–90 years with a recent fracture visiting the FLS.

Methods

In this cross-sectional cohort study, comorbidities were classified according to ICD-10 and medications according to the Anatomic Therapeutic Chemical (ATC) classification and further categorized into those associated BRR and FRR.

Results

Of 1282 patients (72% women; 65 ± 9 years), 53% had at least one BRR, 46% had at least one FRR, and 66% at least one BRR and/or FRR. At least one BRR, as well as at least one FRR were associated with age, BMI, and fracture type, but not with gender or BMD. The proportion of patients with only BRR (± 20%) or only FRR (± 10%) was similar among ages, gender, BMI, fracture type, and BMD. The combination of at least one BRR and at least one FRR was significantly associated with age, BMI, and major fractures, but not with gender or BMD.

Conclusion

Comorbidities and medications associated with increased fracture risk are present in two-thirds of patients visiting the FLS. In addition, the proportion of patients having a combination of BRR and FRR increased significantly with age, BMI, and fracture severity. This indicates that systematic evaluation of these factors is important for a more profound assessment of subsequent fracture risk in FLS care.

Available only for authorised users

Kanis JA, Johnell O, Oden A et al (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11:669–674. https://doi.org/10.1007/s001980070064 CrossRefPubMed

van Staa TP, Dennison EM, Leufkens HGM, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29:517–522. https://doi.org/10.1016/S8756-3282(01)00614-7 CrossRefPubMed

Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. Arch Osteoporos 8:136. https://doi.org/10.1007/s11657-013-0136-1 CrossRefPubMedPubMedCentral

Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382. https://doi.org/10.1016/j.bone.2004.03.024 CrossRefPubMed

Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297:387–394. https://doi.org/10.1001/jama.297.4.387 CrossRefPubMed

Klotzbuecher CM, Ross PD, Landsman PB et al (2010) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739. https://doi.org/10.1359/jbmr.2000.15.4.721 CrossRef

van Geel AC, Geusens PP, Nagtzaam IF et al (2006) Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study. BMC Med 4:1–7. https://doi.org/10.1186/1741-7015-4-24 CrossRef

Dutch Institute for Healthcare Improvement CBO (2011) Richtlijn Osteoporose en Fractuurpreventie, Derde Herziening [Dutch] Utrecht, Dutch Institute for Healthcare Improvement CBO, The Netherlands

Compston J, Bowring C, Cooper A et al (2013) Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas 75:392–396. https://doi.org/10.1016/j.maturitas.2013.05.013 CrossRefPubMed

10.

Cosman F, de Beur SJ, LeBoff MS et al (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381. https://doi.org/10.1007/s00198-014-2794-2 CrossRefPubMedPubMedCentral

11.

Eisman JA, Bogoch ER, Dell R et al (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27:2039–2046. https://doi.org/10.1002/jbmr.1698 CrossRefPubMed

12.

Lems WF, Dreinhöfer KE, Bischoff-Ferrari H et al (2016) EULAR/EFFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. https://doi.org/10.1136/annrheumdis-2016-210289

13.

IOF Fracture Working Group, Åkesson K, Marsh D et al (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152. https://doi.org/10.1007/s00198-013-2348-z CrossRefPubMedCentral

14.

Bours SPG, van Geel TACM, Geusens PPMM et al (2011) Contributors to secondary osteoporosis and metabolic bone diseases in patients presenting with a clinical fracture. J Clin Endocrinol Metab 96:1360–1367. https://doi.org/10.1210/jc.2010-2135 CrossRefPubMed

15.

Center JR, Nguyen TV, Schneider D et al (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. The Lancet 353:878–882. https://doi.org/10.1016/S0140-6736(98)09075-8 CrossRef

16.

World Health Organisation (2003) Prevention and management of osteoporosis, World Health Organization Technical Report Series, vol. 921, pp. 1–164

17.

World Health Organization WHO international statistical classification of diseases and related health problems 10^th revision

18.

IOF CSA Fracture Working Group, Marsh D, Åkesson K et al (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22:2051–2065. https://doi.org/10.1007/s00198-011-1642-x CrossRef

19.

World Health Organization (2007) WHO global report on falls prevention in older age.

20.

Dutch Institute for Healthcare Improvement CBO (2004) Richtlijn Preventie van valincidenten bij ouderen [Dutch] Utrecht, Dutch Institute for Healthcare Improvement CBO, The Netherlands

21.

National Institute for Health and Care Excellence (2015) Falls in older people.

22.

Panel on falls prevention, American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons (2001) Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 49(5):664–72

23.

Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society (2011) Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148–157. https://doi.org/10.1111/j.1532-5415.2010.03234.x CrossRef

24.

WHO Collaborating Centre for Drug Statistics Methodology (2016) Guideline for ATC classification and DDD assignment, 20th edition

25.

Sjöberg C, Bladh L, Klintberg L et al (2010) Treatment with fall-risk-increasing and fracture-preventing drugs before and after a hip fracture: an observational study. Drugs Aging 27:653–661. https://doi.org/10.2165/11538200-000000000-00000 CrossRefPubMed

26.

Woolcott JC, Richardson KJ, Wiens MO et al (2009) Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 169:1952–1960CrossRef

27.

Ham AC, Swart KMA, Enneman AW et al (2014) Medication-related fall incidents in an older, ambulant population: the B-PROOF study. Drugs Aging 31:917–927. https://doi.org/10.1007/s40266-014-0225-x CrossRefPubMed

28.

Munson JC, Bynum JPW, Bell J-E et al (2016) Patterns of prescription drug use before and after fragility fracture. JAMA Intern Med 176:1531–1538. https://doi.org/10.1001/jamainternmed.2016.4814 CrossRefPubMedPubMedCentral

29.

Hippisley-Cox J, Coupland C (2009) Predicting risk of osteoporotic fracture in men and women in England and Wales: prospective derivation and validation of QFractureScores. BMJ 339:b4229–b4229. https://doi.org/10.1136/bmj.b4229 CrossRefPubMedPubMedCentral

30.

Kanis JA, Oden A, Johnell O et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046. https://doi.org/10.1007/s00198-007-0343-y CrossRefPubMed

31.

Nguyen ND, Frost SA, Center JR et al (2007) Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporos Int 18:1109–1117. https://doi.org/10.1007/s00198-007-0362-8 CrossRefPubMed

32.

Nguyen ND, Frost SA, Center JR et al (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19:1431–1444. https://doi.org/10.1007/s00198-008-0588-0 CrossRefPubMed

33.

Ganda K, Schaffer A, Seibel MJ (2014) Predictors of re-fracture amongst patients managed within a secondary fracture prevention program: a 7-year prospective study. Osteoporos Int 26:543–551. https://doi.org/10.1007/s00198-014-2880-5 CrossRefPubMed

34.

Eekman DA, van Helden SH, Huisman AM et al (2013) Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporos Int 25:701–709. https://doi.org/10.1007/s00198-013-2481-8 CrossRefPubMed

35.

Malgo F, Appelman-Dijkstra NM, Termaat MF et al (2016) High prevalence of secondary factors for bone fragility in patients with a recent fracture independently of BMD. Arch Osteoporos 11:12. https://doi.org/10.1007/s11657-016-0258-3 CrossRefPubMedPubMedCentral

36.

van Helden S, van Geel AC, Geusens PP et al (2008) Bone and fall-related fracture risks in women and men with a recent clinical fracture. J Bone Joint Surg Am Vol 90:241–248. https://doi.org/10.2106/JBJS.G.00150 CrossRef

37.

Naranjo A, Ojeda-Bruno S, Bilbao Cantarero A et al (2014) Results of a model of secondary prevention for osteoporotic fracture coordinated by rheumatology and focused on the nurse and primary care physicians. Reumatol Clín (English Edition) 10:299–303. https://doi.org/10.1016/j.reumae.2014.03.004 CrossRef

Title: Comorbidities and medication use in patients with a recent clinical fracture at the Fracture Liaison Service
Authors: L. Vranken
C. E. Wyers
R. Y. Van der Velde
H. M. Janzing
S. Kaarsemaker
P. P. Geusens
J. P. Van den Bergh
Publication date: 01-02-2018
Publisher: Springer London
Published in: Osteoporosis International / Issue 2/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-017-4290-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Comorbidities and medication use in patients with a recent clinical fracture at the Fracture Liaison Service

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

A case of regional migratory osteoporosis

Geisinger high-risk osteoporosis clinic (HiROC): 2013–2015 FLS performance analysis

The effect of insulin on bone mineral density among women with type 2 diabetes: a SWAN Pharmacoepidemiology study

Two threshold levels of vitamin D and the prevalence of comorbidities in outpatients of a tertiary hospital

Standards of reporting: the use of CONSORT PRO and CERT in individuals living with osteoporosis

Teriparatide for treatment of patients with bisphosphonate-associated atypical fracture of the femur