Imminent fracture risk assessments in the UK FLS setting: implications and challenges

Pinedo-Villanueva, Rafael; Charokopou, M.; Tóth, Emese; Donnelly, Kerry; Cooper, Cyrus; Prieto‐Alhambra, Daniel; Libanati, Cesar; Javaid, M K

doi:10.1007/s11657-019-0569-2

Cited by 34 publications

(26 citation statements)

References 41 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Our findings are supported by results of previous studies, where 18% of women ≥65 years and 11-12% of women ≥50 years sustained a second osteoporotic fracture within 2 years of an index fracture [21,36,37]. Studies examining fracture risk over time after an incident fracture have demonstrated a 2.7 to 5-fold higher fracture risk within 1-2 years post-fracture (ie, imminent risk) compared to 1.4 to 2-fold higher 10year risk [12,38].…”

Section: Discussionsupporting

confidence: 90%

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

Adachi

Brown

Schemitsch

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background The secondary fracture prevention gap in the osteoporosis field has been previously described as a ‘crisis’. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1–2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures. Methods This retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized. Results Among 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236–955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture. Conclusions This cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated.

show abstract

Section: Discussionsupporting

confidence: 90%

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

Adachi

Brown

Schemitsch

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…These events can occur in up to 23.2% of patients [70] and risk factors include recent fracture, fracture site, older age, osteoporosis and comorbidities, e.g., cognitive dysfunction, central nervous system polypharmacy, reduced physical activity, poorer general health as well as falls [71,72]. This supports the notion of early identification, assessment and treatment of those most at risk with the FLS model to reduce the future burden of fracture [73].…”

Section: Assessment Of Riskmentioning

confidence: 85%

Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people

et al. 2021

View full text Add to dashboard Cite

Osteoporosis, a common chronic metabolic bone disease is associated with considerable morbidity and mortality. As the prevalence of osteoporosis increases with age, a paralleled elevation in the rate of incident fragility fractures will be observed. This narrative review explores the origins of bone and considers physiological mechanisms involved in bone homeostasis relevant to management and treatment. Secondary causes of osteoporosis, as well as osteosarcopenia are discussed followed by an overview of the commonly used pharmacological treatments for osteoporosis in older people.

show abstract

“…For example, for patients in whom there is particular urgency to build BMD and quickly reduce fracture risk, a bone-forming agent may be prescribed prior to transitioning the patient to an antiresorptive therapy-an approach validated by the recent VERO and ARCH studies of teriparatide (Forteo, Eli Lilly, Indianapolis, IN) and romosozumab (Evenity, Amgen, Thousand Oaks, CA), respectively [34,35]. Roux and Briot [36] have offered a framework for understanding and using information on imminent risk in the routine care setting, and a 2019 paper by Pinedo-Villanueva et al [37] has recommended the assessment of imminent risk in the fracture liaison service (FLS) setting to identify the patients most in need of treatment with potent anti-osteoporosis medications with a rapid onset of action. Imminent risk assessment may also help clinicians tailor other patient support efforts, such as education on fall prevention and management of comorbidities and medications that may increase risk for fracture.…”

Section: Discussionmentioning

confidence: 99%

Determinants of imminent fracture risk in postmenopausal women with osteoporosis

et al. 2020

View full text Add to dashboard Cite

In elderly women with osteoporosis, prior fracture, low BMD, impaired physical functioning, poorer general health, and recent falls were all direct predictors of imminent (in next year) fracture risk. Prior fracture, older age, worse health, impaired cognitive functioning, and recent falls indirectly increased imminent risk by reducing physical functioning/general health. Introduction This study was designed to examine determinants of imminent risk of osteoporotic fracture (i.e., next 1-2 years) in postmenopausal women. Methods This retrospective cohort study used data from Caucasian women age 65 or older with osteoporosis who participated in the observational Study of Osteoporotic Fractures (SOF). We examined potential direct and indirect predictors of hip and nonvertebral fractures in 1-year follow-up intervals including anthropometric measures, bone mineral density (T-score), fracture since age 50, physical function, cognition, medical conditions, recent (past year) falls, and lifestyle factors. Clinically related variables were grouped into constructs via factor analysis. These constructs and selected individual variables were incorporated into a theoretical structural equation model to evaluate factors that influence imminent risk. Results Among 2261 patients, 19.4% had a nonvertebral fracture and 5.5% had a hip fracture within 1 year of a study visit between 1992 and 2008. Prior fracture, lower T-scores, lower physical functioning, and recent falls all directly increased 1-year risk of nonvertebral fracture. For both nonvertebral and hip fractures, prior fracture and recent falls influenced risk indirectly through general health, while cognition influenced risk via physical functioning. Age influenced both physical functioning and general health. Conclusions Several established risk factors for 10-year fracture risk also played a role in predicting imminent risk of fracture (e.g., T-scores, prior fracture), as did falls, cognition, physical functioning, and general health. Fracture risk assessments should also consider falls and fall risk factors as well as established bone-related risk factors in assessing imminent fracture risk.

show abstract

Imminent fracture risk assessments in the UK FLS setting: implications and challenges

Abstract: With the recognition that a sentinel fracture leads to a high imminent risk of fracture, we discuss the implications and challenges of using imminent fracture risk in the secondary fracture prevention setting.

Cited by 34 publications

References 41 publications

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people

Determinants of imminent fracture risk in postmenopausal women with osteoporosis

Contact Info

Product

Resources

About