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Archives of Osteoporosis

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01-12-2022 | Refracture | Original Article

Risk factors of refracture after a fragility fracture in elderly

Authors: Kaiwan Sriruanthong, Nattaphon Philawuth, Surapot Saloa, Nuttorn Daraphongsataporn, Worapong Sucharitpongpan

Published in: Archives of Osteoporosis | Issue 1/2022

Abstract

Summary

The study examined the risk factors of recurrent fragility fractures in elderly. Female and older age increased the risk of refracture. Older age at the first fracture also resulted in shorter time to the second fracture. The prevention program should be emphasized.

Purpose

The study examined the characteristics of the fragility fractures and refractures and the factors affecting the incidence and duration to the second fragility fracture.

Methods

The retrospective cohort study reviewed electronic medical records from Nan Provincial Public Health Office, Thailand. Patients aged ≥ 60 years with fragility fractures (hip, wrist, vertebra, and proximal humerus) from low-energy injuries between 1 January 2009 and 31 December 2018 were included. The characteristics of the first and second fractures and the factors that had effect on refracture incidence and duration were investigated.

Results

Among 4322 patients, 306 patients (7%) had subsequent fragility fractures. Risk factors of refracture included female (adjusted odd ratio 1.79, 95%CI 1.304–2.467) and older age at the first fracture (adjusted odd ratio 1.016, 95%CI 1.003–1.029). Factor resulted in shorter time to second fracture was older age at the first fracture (β-coefficient − 0.96, 95%CI − 1.4–(− 0.5)). Any type of the first fracture resulted in similar risk and duration to subsequent fracture. Half (48%) and two-third (65%) of the second fractures occurred within 3 and 4 years, respectively.

Conclusion

Female and older age were risk factors of subsequent fragility fracture. Older age resulted in shorter time to the second fracture. Refracture prevention program should be initiated in patients with any type of first fragility fracture and should be continued for at least 3–4 years.

Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297(4):387–394. https://doi.org/10.1001/jama.297.4.387CrossRefPubMed

Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS et al (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18(11):1947–1954. https://doi.org/10.1359/jbmr.2003.18.11.1947CrossRefPubMed

Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8(1):136. https://doi.org/10.1007/s11657-013-0136-1CrossRefPubMedPubMedCentral

Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767. https://doi.org/10.1016/s0140-6736(02)08657-9CrossRefPubMed

Odén A, McCloskey EV, Kanis JA, Harvey NC, Johansson H (2015) Burden of high fracture probability worldwide: secular increases 2010–2040. Osteoporos Int 26(9):2243–2248. https://doi.org/10.1007/s00198-015-3154-6CrossRefPubMed

Leboime A, Confavreux CB, Mehsen N, Paccou J, David C, Roux C (2010) Osteoporosis and mortality. Joint Bone Spine 77(Suppl 2):S107-12. https://doi.org/10.1016/s1297-319x(10)70004-xCrossRefPubMed

Gibson-Smith D, Klop C, Elders PJ, Welsing PM, van Schoor N, Leufkens HG et al (2014) The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000–2010. Osteoporos Int 25(11):2555–2563. https://doi.org/10.1007/s00198-014-2799-xCrossRefPubMed

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382. https://doi.org/10.1016/j.bone.2004.03.024CrossRefPubMed

Montoya-García MJ, Giner M, Marcos R, García-Romero D, Olmo-Montes FJ, Miranda MJ et al. (2021) Fragility fractures and imminent fracture risk in the Spanish population: a retrospective observational cohort study. J Clin Med 10(5). https://doi.org/10.3390/jcm10051082

10.

Shim YB, Park JA, Nam JH, Hong SH, Kim JW, Jeong J et al (2020) Incidence and risk factors of subsequent osteoporotic fracture: a nationwide cohort study in South Korea. Arch Osteoporos 15(1):180. https://doi.org/10.1007/s11657-020-00852-yCrossRefPubMed

11.

Wong RMY, Ho WT, Wai LS, Li W, Chau WW, Chow KS et al (2019) Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies. Arch Osteoporos 14(1):104. https://doi.org/10.1007/s11657-019-0648-4CrossRefPubMed

12.

Tsuda T (2017) Epidemiology of fragility fractures and fall prevention in the elderly: a systematic review of the literature. Curr Orthop Pract 28(6):580–585. https://doi.org/10.1097/bco.0000000000000563CrossRefPubMedPubMedCentral

13.

Yamanashi A, Yamazaki K, Kanamori M, Mochizuki K, Okamoto S, Koide Y et al (2005) Assessment of risk factors for second hip fractures in Japanese elderly. Osteoporos Int 16(10):1239–1246. https://doi.org/10.1007/s00198-005-1835-2CrossRefPubMed

14.

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 30(3):601–609. https://doi.org/10.1007/s00198-019-04852-8CrossRefPubMedPubMedCentral

15.

Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S et al (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25(10):2359–2381. https://doi.org/10.1007/s00198-014-2794-2CrossRefPubMedPubMedCentral

16.

Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15(4):721–739. https://doi.org/10.1359/jbmr.2000.15.4.721CrossRefPubMed

17.

Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114(11):919–923. https://doi.org/10.7326/0003-4819-114-11-919CrossRefPubMed

18.

Cuddihy MT, Gabriel SE, Crowson CS, O’Fallon WM, Melton LJ 3rd (1999) Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int 9(6):469–475. https://doi.org/10.1007/s001980050172CrossRefPubMed

19.

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 134:115286. https://doi.org/10.1016/j.bone.2020.115286CrossRefPubMed

20.

Dang DY, Zetumer S, Zhang AL (2019) Recurrent fragility fractures: a cross-sectional analysis. J Am Acad Orthop Surg 27(2):e85–e91. https://doi.org/10.5435/jaaos-d-17-00103CrossRefPubMed

21.

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 30(1):79–92. https://doi.org/10.1007/s00198-018-4732-1CrossRefPubMed

22.

Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A et al (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporos Int 11(8):669–674. https://doi.org/10.1007/s001980070064CrossRefPubMed

23.

Ensrud KE, Blackwell TL, Fink HA, Zhang J, Cauley JA, Cawthon PM et al (2016) What proportion of incident radiographic vertebral fractures in older men is clinically diagnosed and vice versa: a prospective study. J Bone Miner Res 31(8):1500–1503. https://doi.org/10.1002/jbmr.2831CrossRefPubMed

24.

Kendler DL, Bauer DC, Davison KS, Dian L, Hanley DA, Harris ST et al (2016) Vertebral fractures: clinical importance and management. Am J Med 129(2):221.e1–10. https://doi.org/10.1016/j.amjmed.2015.09.020CrossRefPubMed

25.

Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288. https://doi.org/10.1007/s00198-011-1601-6CrossRefPubMedPubMedCentral

26.

Baba T, Hagino H, Nonomiya H, Ikuta T, Shoda E, Mogami A et al (2015) Inadequate management for secondary fracture prevention in patients with distal radius fracture by trauma surgeons. Osteoporos Int 26(7):1959–1963. https://doi.org/10.1007/s00198-015-3103-4CrossRefPubMed

27.

Osuna PM, Ruppe MD, Tabatabai LS (2017) Fracture liaison services: multidisciplinary approaches to secondary fracture prevention. Endocr Pract 23(2):199–206. https://doi.org/10.4158/ep161433.raCrossRefPubMed

28.

Frenkel Rutenberg T, Vitenberg M, Haviv B, Velkes S (2018) Timing of physiotherapy following fragility hip fracture: delays cost lives. Arch Orthop Trauma Surg 138(11):1519–1524. https://doi.org/10.1007/s00402-018-3010-1CrossRefPubMed

29.

Wasfie T, Jackson A, Brock C, Galovska S, McCullough JR, Burgess JA (2019) Does a fracture liaison service program minimize recurrent fragility fractures in the elderly with osteoporotic vertebral compression fractures? Am J Surg 217(3):557–560. https://doi.org/10.1016/j.amjsurg.2018.09.027CrossRefPubMed

30.

Bonafede M, Shi N, Barron R, Li X, Crittenden DB, Chandler D (2016) Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data. Arch Osteoporos 11(1):26. https://doi.org/10.1007/s11657-016-0280-5CrossRefPubMedPubMedCentral

31.

Kanis JA, Cooper C, Rizzoli R, Abrahamsen B, Al-Daghri NM, Brandi ML et al (2017) Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int 28(7):2023–2034. https://doi.org/10.1007/s00198-017-4009-0CrossRefPubMedPubMedCentral

32.

Roux C, Briot K (2017) Imminent fracture risk. Osteoporos Int 28(6):1765–1769. https://doi.org/10.1007/s00198-017-3976-5CrossRefPubMed

Title: Risk factors of refracture after a fragility fracture in elderly
Authors: Kaiwan Sriruanthong
Nattaphon Philawuth
Surapot Saloa
Nuttorn Daraphongsataporn
Worapong Sucharitpongpan
Publication date: 01-12-2022
Publisher: Springer London
Keyword: Refracture
Published in: Archives of Osteoporosis / Issue 1/2022
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-022-01143-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors of refracture after a fragility fracture in elderly

Abstract

Summary

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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