Post-fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine; Stenbro, May-Britt; Hübschle, Lars Michael; Froholdt, Anne; Figved, Wender; Apalset, Ellen M; Gjertsen, Jan‐Erik; Basso, Trude; Lund, Ida Katrine; Hansen, Ann Kristin; Stutzer, Jens-Meinhard; Omsland, Tone Kristin; Nordsletten, Lars; Frihagen, Frede; Eriksen, Erik Fink

doi:10.1002/jbmr.3827

Cited by 14 publications

(9 citation statements)

References 34 publications

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“…Thus, in this prospective analysis including slight changes compared to the classification of fracture sites proposed by Borgen and colleagues, (1) a central (trunk) fracture appeared to be more predictive of further fractures than MOFs, which strengthens the interest of the new classification proposed by Borgen and colleagues. (1)…”

Section: To the Editorsupporting

confidence: 79%

“…MOFs are presently the main pillar of osteoporosis diagnosis and treatment: they are used as predictor of future incident fractures (2)(3)(4) ; in countries using the FRAX© to help decision of osteoporosis treatment, the main concern is about the absolute risk of MOFs, with a usual threshold of 20% at 10 years. (5,6) In order to examine how the classification proposed by Borgen and colleagues (1) would change the prediction power of a prevalent fracture for an incident fracture, we analyzed data of our ongoing Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) cohort and compared the hazard ratio (HR) for a MOF or a new central fracture after a first incident fracture.…”

Section: To the Editormentioning

confidence: 99%

“…For our analysis, we somewhat modified and simplified the classification proposed by Borgen and colleagues. (1) We also considered as central fractures those of the ribs, scapula, clavicles, and sternum, which belong to the trunk, and all others as peripheral (Borgen and colleagues (1) did not have rib fractures in their cohort, did not mention sternum or scapula, and included the clavicles in the peripheral group). We propose these minor changes for the sake of simplification; ie, fractures of the "trunk" versus peripheral fractures.…”

Section: To the Editormentioning

confidence: 99%

“…

We read with interest the article from Borgen and colleagues (1) recently published in the Journal of Bone Mineral Research (JBMR), proposing a reclassification of the sites of fractures in central and peripheral fractures because of clinical and densitometric similarities in patients who underwent either central fractures or peripheral fractures. They found that, indeed, patients with an index fracture at central sites exhibited lower BMD, lower trabecular bone score (TBS), and higher prevalence of vertebral fractures on vertebral fracture assessment (VFA) than patients with peripheral fractures.This new classification differs from the classical grouping of major osteoporotic fractures (MOFs) because MOFs do not include central sites such as the pelvis, but include a peripheral site, the wrist, and it could modify the fracture prediction strategy, which is based essentially on MOFs.

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confidence: 99%

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Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Kinnard

Baleanu

Iconaru

et al. 2020

Journal of Bone and Mineral Research

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Section: To the Editorsupporting

confidence: 79%

Section: To the Editormentioning

confidence: 99%

Section: To the Editormentioning

confidence: 99%

“…

…”

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confidence: 99%

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Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Kinnard

Baleanu

Iconaru

et al. 2020

Journal of Bone and Mineral Research

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“…This cross-sectional sub-study (NCT02608801) of NoFRACT (NCT02536898) included patients at the University Hospital of North Norway, Tromsø, from 1 Oct 2015 to 31 Dec 2017 and at Drammen Hospital in the south-eastern part of Norway from 1 Jan 2016 to 31 Dec 2017 [23,25]. Of all patients of 50 years of age and above, attending to these hospitals with a fragility fracture, more than 90% (n = 2682) were identified and offered fracture risk assessment.…”

Section: Study Subjectsmentioning

confidence: 99%

Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT

et al. 2019

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Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1-SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1-SQ3 fractures. SQ1-SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS. Introduction Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1-SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1-SQ3 fractures. Methods This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1-SQ3 fracture assessed. Results Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1-SQ3 fractures. In multiple variable analysis, higher age (β per SD = − 0.26, 95% CI: − 0.36,− 0.15), parental hip fracture (β = − 0.29, 95% CI: − 0.54,− 0.05), and daily alcohol intake (β = − 0.43, 95% CI − 0.79, − 0.08) were associated with lower TBS. Higher BMD of femoral neck (β per SD = 0.34, 95% CI 0.25-0.43) and lumbar spine (β per SD = 0.40, 95% CI 0.31-0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (OR per SD = 1.94, 95% CI 1.51-2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09-2.71) were positively associated with SQ1-SQ3 fractures, while lumbar spine BMD (OR per SD = 0.75 95% CI 0.60-Osteoporosis International (2020) 31:505-514 https://doi.# The Author(s) 2019 0.95) was negatively associated with SQ1-SQ3 fractures. No association between TBS and SQ1-SQ3 fractures was found. Conclusion Since TBS and SQ1-SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.

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Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

et al. 2021

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Severe osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Post-fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Cited by 14 publications

References 34 publications

Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT

Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study

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