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THU0381 Up to Half of First Fragility Fractures (FF), and a Third of Recurrent FF, Occur in Patients with Low or Moderate Estimated Frax® 10-Year Fracture Risk: Results from the Optimus Initiative
  1. P.-M. April1,
  2. F. Cabana2,
  3. M.-C. Beaulieu3,
  4. M. Beaulieu4,
  5. S. Roux5,
  6. G. Boire5
  1. 1Faculty of Medicine and Health Sciences, Université de Sherbrooke
  2. 2Department of Surgery, Division of Orthopaedics, Centre Hospitalier Universitaire de Sherbrooke
  3. 3Department of Family Medicine, Université de Sherbrooke, Sherbrooke
  4. 4Program for Optimal Management of Health Services, Merck Canada, Montréal
  5. 5Department of Medicine Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada


Background Identification of patients who will sustain a fragility fracture (FF) is the main objective of the WHO Fracture Risk Assessment score (FRAX®).

Objectives To describe the FRAX scores at the time of an incident FF and the rates of subsequent fractures according to FRAX category over 4 years following this clinical FF.

Methods An ongoing prospective cohort of men and women over 50 years of age was followed up in the OPTIMUS study, a placebo-controlled intervention aimed at increasing the rate of initiation and persistence on osteoporosis treatment after an incident FF leading to an orthopaedic consultation. At year 1, 56% were then receiving an effective osteoporosis treatment. The occurrence of novel FF was obtained from patients during phone follow-ups over 4 years. Canadian-adjusted FRAX scores were calculated from baseline and follow up information, without BMD.

Results From January 2007 to June 2011, 1172 patients (961 women; Mean age 68.6 years) with FF were included. FRAX score was not calculated in 20 patients because of missing height and/or weight values. BEFORE the incident FF, 596/1152 (51.7%) were attributed a Low, 70 (6.1%) a Moderate, and 486 (42.2%) a High risk, according to FRAX. AFTER the fracture, 314 (27.3%) patients were still scored Low, 217 (18.8%) Moderate and 621 (53.9%) High risks. Prior (After) the FF, FRAX-estimated risk was estimated High in 74.2 (86.2)% of Hip, 47.0 (55.0)% of Proximal Humerus, 47.1 (64.7)% of vertebra, 34.8 (48.9)% of wrist, 20.7 (30.0)% of ankle and 36.1 (50.4)% of Other Minor sites, respectively. Over 2285 patient-years of follow up, 99 recurrent FF occurred in 86 patients. The 10-year risk was estimated as High in 57 (66.3%) episodes of recurrent FF. Odds ratios (ORs) for recurrent fractures were thus 1.77 [CI 1.01-3.09] for post-FF High vs Low risk, and 1.02 [CI 0.48-2.19] for Moderate vs Low risk patients.

Conclusions The Canadian-adjusted FRAX® High-risk category was NOT sensitive to identify patients BEFORE they sustained an incident FF: 74% of Hip but only 34% of non-Hip FF. Thus, Primary intervention based on FRAX® High Risk only is unlikely to decrease non-Hip fracture rates. Relative to High risk defined as ≥20% for Major FF only, combining estimated risk ≥3% for Hip with risk ≥20% for Major FF increased the size of the High risk category by over 60%, mostly at the expense of the Moderate category. AFTER an incident FF, the FRAX® High-risk category was statistically but not CLINICALLY useful to predict which patient would present a subsequent FF (66% of all recurrent FF patients; OR < 2 for High versus Low and Moderate risk). Even patients with incident FF at Minor sites and those classified post-FF at FRAX® Low/Moderate risk had high rates of recurrent FF. This suggests that all recent FF patients might be considered for therapy, irrespective of their FRAX® estimated 10-year risk.

Disclosure of Interest P.-M. April: None Declared, F. Cabana: None Declared, M.-C. Beaulieu: None Declared, M. Beaulieu Employee of: Merck Canada, S. Roux: None Declared, G. Boire Grant/research support from: Merck Canada, The Alliance for Better Bone Health, Novartis Canada, Amgen Canada, Warner Chilcott Canada, Servier Canada

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