Background Although the increase in risk for subsequent fracture following an incident fragility fracture (FF) is well-documented, the impact of the non-vertebral FF site on short-term subsequent fracture risk is less well defined.
Objectives To describe the rates of subsequent fractures over the first 3 years following a non-vertebral FF according to site of initial FF and to subsequent treatment status.
Methods An ongoing prospective cohort of men and women over 50 years of age was followed up in the OPTIMUS study, an intervention aimed at increasing the rate of initiation and persistence on osteoporosis treatment after an incident non-vertebral FF. The consenting participants were counselled about osteoporosis and its relationship to FF. A letter also informed their Family Physician to stress the importance of treating osteoporosis unmasked by a FF, with reminders sent if patients were still untreated at the time of regular phone follow-up. At year 1, the delivery of anti-osteoporosis medication was confirmed with the patients’ pharmacists (56% were then appropriately treated). The occurrence of recurrent FF was obtained from patients during phone follow-ups.
Results From January 2007 to June 2011, 1165 patients (961 women, 204 men) with non-vertebral FF were included in the OPTIMUS intervention, including 200 control patients and 229 hip fractures. Twenty percent of the approached patients refused to participate. The mean age of the patients was 67.4 years. Follow up was obtained from 851/906 (93.9%), 681/730 (93.2%) and 444/510 (87.1%) surviving patients at year 1, 2, and 3, respectively. The incidence of recurrent fracture after any FF in our cohort was 48.6, 45.9 and 40.6 per 1000 patient-years over the first, second and third year, respectively; this means 135.1 fractures per 1000 patients over the first 3 years. Incidence rates of FF markedly decreased in patients treated with effective Osteoporosis medications (from 65.6 to 50.5 to 25.6 per 1000 patient-years, in the first, second and third year, respectively) and significantly increased in untreated patients (from 37.6 to 46.2 to 55.0 per 1000 patient-years from the first to the third year, respectively). Rates per 1000 patient-years decreased markedly over 3 years after Hip (64.1, 61.4 and 34.5), Humerus (60.7, 29.2 and 33.7) and Other fractures (78.0, 81.4 and 50.8), but increased after wrist (44.7, 54.2 and 40.0) and ankle FF (20.9, 38.1 and 48.1).
Conclusions Initial fracture rates were highest for Hip, Humerus and Other FF, but these rates decreased over time as treatment rates increased. Rates of recurrent fractures increased over time after wrist and ankle FFs; these FF occur in younger individuals that are seldom treated. While wrist and ankle fractures are considered relatively benign, our data indicates that wrist and ankle FF patients already present 13.9% and 10.7% of recurrent fractures over the first 3 years, respectively; there is also a trend for fracture rates to increase over time in these patients. As these results apply to relatively healthy patients who were apt to consent, this high rate of short-term recurrent fracture may still be an underestimation.
Disclosure of Interest F. Cabana: None Declared, S. Roux: None Declared, M.-C. Beaulieu: None Declared, M. Beaulieu Employee of: Merck Canada Inc., G. Boire Grant/Research support from: Merck Canada Inc.; Alliance for Better Bone Health; Novartis Canada; Amgen Canada; Servier Canada
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