Fragility Fractures and Imminent Fracture Risk in the Spanish Population: A Retrospective Observational Cohort Study

Abstract

Fragility fractures constitute a major public health problem worldwide, causing important high morbidity and mortality rates. The aim was to present the epidemiology of fragility fractures and to assess the imminent risk of a subsequent fracture and mortality. This is a retrospective population-based cohort study (n = 1369) with a fragility fracture. We estimated the incidence rate of index fragility fractures and obtained information on the subsequent fractures and death during a follow-up of up to three years. We assessed the effect of age, sex, and skeletal site of index fracture as independent risk factors of further fractures and mortality. Incidence rate of index fragility fractures was 86.9/10,000 person-years, with highest rates for hip fractures in women aged ≥80 years. The risk of fracture was higher in subjects with a recent fracture (Relative Risk(RR), 1.80; p < 0.01). Higher age was an independent risk factor for further fracture events. Significant excess mortality was found in subjects aged ≥80 years and with a previous hip fracture (hazard ratio, 3.43 and 2.48, respectively). It is the first study in Spain to evaluate the incidence of major osteoporotic fractures, not only of the hip, and the rate of imminent fracture. Our results provide further evidence highlighting the need for early treatment.

Cost-Effectiveness Analysis of Fracture Liaison Services Compared with Standard of Care in the Secondary Prevention of Fragility Fractures in Spain

“… 2 An incidence rate of fragility fractures of 86.9/10,000 person-years in Spain is estimated. 3 In 2017, up to 330,000 fragility fractures occurred in Spain, with an estimated associated cost of 4.2 billion euros. 4…”

Spanish National Registry of Major Osteoporotic Fractures (REFRA) seen at Fracture Liaison Services (FLS): objectives and quality standards

“…The same report estimated a loss of 1 million quality-adjusted life years (QALYs) in 2017 alone due to fragility fractures, and 21 disability-adjusted life years (DALYs) per 1000 individuals aged 50 years and above, exceeding the estimated impact of stroke or chronic obstructive pulmonary disease. Furthermore, all-cause death is increased by more than two times in the year following hip fragility fracture [ 5 ].…”

“…Within Spain, there are also some differences in the reported incidence rates of fractures between regions. While in Andalusia the incidence rates among individuals over 50 years of age were 123.9 cases and 86.9 cases per 10,000 person years for females and males, respectively [ 5 ], the corresponding estimates in Catalonia were 149.7 and 54.6 [ 9 ].…”

“…The occurrence of a first fragility fracture has been shown to increase the risk of subsequent fractures by 80% [ 5 , 10 ]. Furthermore, this elevated risk of refracture is concentrated immediately after the initial fracture [ 5 , 11 ], in what it has been defined as an “imminent risk period.” This period comprises a window of opportunity to identify patients at high risk and to initiate therapies aimed at preventing future fractures.…”

“…The occurrence of a first fragility fracture has been shown to increase the risk of subsequent fractures by 80% [5,10]. Furthermore, this elevated risk of refracture is concentrated immediately after the initial fracture [5,11], in what it has been defined as an "imminent risk period."…”