Abstract
SummaryIn this study, we demonstrate a high prevalence of secondary factors in patients with a recent fracture independently of bone mineral density (BMD). Our results suggest that patients with a recent fracture should be screened for secondary factors for bone fragility regardless of BMD values.IntroductionSecondary factors for bone fragility are common in patients with osteoporosis who have sustained a fracture. The majority of fragility fractures occurs, however, in patients with osteopenia, and it is not known whether secondary factors may contribute to fracture risk in these patients or in those with normal BMD.MethodsProspective cohort study evaluating the prevalence of secondary factors for bone fragility in consecutive patients referred to our fracture liaison service from June 2012 to June 2014 after a recent fracture.ResultsSeven hundred nine patients were included, 201 (28 %) with osteoporosis, 391 (55 %) with osteopenia and 117 (17 %) with normal BMD. Mean age was 66.0 ± 9.8 years, 504 (73 %) were women and 390 (57 %) had one or more underlying secondary factor. Evaluation of clinical risk factors using fracture risk assessment tool (FRAX) identified 38 % of patients with ≥1 secondary factor including smoking (18 %), excessive alcohol use (12 %), glucocorticoid use (12 %) and rheumatoid arthritis (3 %). Laboratory investigations revealed chronic kidney disease in 13 %, monoclonal gammopathy also in 13 % and primary or secondary hyperparathyroidism in 1 and 6 %, respectively. Secondary factors for bone fragility were equally prevalent in patients with osteoporosis, osteopenia or normal BMD.ConclusionsOur findings demonstrate a high prevalence of secondary factors for bone fragility in patients who have sustained a recent fracture, independently of BMD. The significant number of documented factors, which were treatable, suggest that patients who sustained a fracture should be screened for secondary factors for bone fragility regardless of BMD values to optimise secondary fracture prevention.
Highlights
Osteoporotic fragility fractures are associated with increased morbidity and mortality and growing personal, societal and economic burdens [1,2,3,4]
Our findings demonstrate a high prevalence of secondary factors for bone fragility in patients who have sustained a recent fracture, independently of bone mineral density (BMD)
Secondary factors for bone fragility are common in patients with osteoporosis and a fragility fracture [13,14,15], but data on the prevalence of these factors in patients with osteopenia or normal BMD and a fragility fracture are scarce [13, 15]
Summary
Osteoporotic fragility fractures are associated with increased morbidity and mortality and growing personal, societal and economic burdens [1,2,3,4]. Patients who sustain a fracture and who have osteoporosis are offered treatment with bonemodifying agents, but a significant number of patients who sustain a fracture have bone mineral density (BMD) in the osteopenia range [9, 10], and in the Netherlands, these are not generally screened for secondary factors for bone fragility. Secondary factors for bone fragility are common in patients with osteoporosis and a fragility fracture [13,14,15], but data on the prevalence of these factors in patients with osteopenia or normal BMD and a fragility fracture are scarce [13, 15]. To assess the potential contribution of secondary factors for bone fragility to fracture risk, we set out to evaluate the prevalence of these factors in a cohort of patients who had recently sustained a fracture and who were referred to the FLS for further investigation and management
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