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

Abstract

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.

Epidemiology and economic burden of fragility fractures in Austria

“…The findings of this investigation with an approximately 15% increase of fragility fracture occurrence per decade of life in both sexes confirm the magnitude of the population burden in this country. Except for rib fractures, women were affected substantially more frequently, especially at locations such as the forearm (1:6 ratio) and the pelvis (1:5 ratio), which is in line with recently reported data from France [26].…”

“…In a study from France, only 16.7% received a specific osteoporosis treatment in the 12 months after a fracture. The refracture rate within the first year after fracture was 6.3%, with lower rates for multiple rib fractures (4.0%) and higher rates for pelvic fractures (7.8%) [26]. A recent study of the impact of antiosteoporotic drugs and calcium/ vitamin D on refracture in patients with previous fragility fractures showed that over a mean follow-up of 3 years, the risk of subsequent fractures was 44.4% lower in treated patients compared to untreated ones and 77.2% lower in treated patients who were adherent to medication [38].…”

A tissue-specific role of membrane-initiated ERα signaling for the effects of SERMs

“…Cortical bone comprises about 80% of the total bone mass and this bone compartment is important for skeletal strength, not only in long bones, but also in vertebrae (Roux et al, 2021).…”

Morbidity and Mortality After Second Hip Fracture With and Without Nursing Care Program

“…In literature, contralateral osteoporotic hip fractures are reported approximately 8.54% (range 5-10%) [ 19 - 21 ]. Roux et al [ 22 ], in the Fractos study (from the French national healthcare database), evaluated 356,895 patients hospitalized for severe osteoporotic fracture; in the 12 month-period following fracture, only 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate and the all-cause mortality after the hip fracture have been estimated at 7.8% and 12.8%, respectively.…”