Osteoporotic fractures and subsequent fractures: imminent fracture risk from an analysis of German real-world claims data

Peyman Hadji,Bernd Schweikert,Edda Kloppmann,Luis Möckel,Emese Toth,Lars Joeres,Patrick Gille,Claus-C Glüer

doi:10.1007/s00404-021-06123-6

Abstract

PurposeIn osteoporosis, prior fracture is a strong predictor of subsequent fracture. This study aimed to assess the imminent risk of subsequent fracture following an initial fracture in osteoporosis patients in Germany, and to identify clinical and demographic characteristics that are independently associated with subsequent fracture risk.MethodsIn this retrospective, observational cohort study using German real-world claims data, male and female patients aged ≥ 50 years with osteoporosis who experienced an initial (“index”) hip/femur, vertebral, forearm/wrist/hand or shoulder/upper arm fracture between 2010 and 2014 were included. The incidence and timing of subsequent fractures during a 1-year follow-up period were analyzed. Independent risk factors for subsequent fracture were identified by multivariate regression analysis.ResultsA total of 18,354 patients (mean age: 77 years; standard deviation: 9.8) were included. Of these, 2918 (15.9%) suffered a subsequent fracture during the 1-year follow-up period. The incidence of subsequent fracture was higher following an index vertebral fracture (18.0%) than after an index forearm/wrist/hand fracture (14.1%) or index hip/femur fracture (12.1%). Subsequent 1-year fracture incidence was generally higher in older patients. Index fracture type, age, epilepsy/use of antiepileptics, and heart failure were all independently associated with subsequent fracture risk.ConclusionOsteoporosis patients in Germany are at imminent risk of subsequent fracture during the first year following an initial fracture. They should be targeted for immediate post-fracture treatment to reduce the risk of further fractures, especially in the presence of specific risk factors such as old age or index vertebral fracture.

Highlights

Osteoporosis is a progressive, systemic, skeletal disorder characterized by low bone mass, an increase in bone fragility, and susceptibility to fracture
70.8% of patients had an osteoporosis diagnosis prior to index fracture, and the proportion of patients with a diagnosis was greater in females than males (Table 1)
standard deviations (SDs) standard deviation patients with an osteoporosis medication prescription was greater in females than males (Table 1)

Summary

Introduction

Osteoporosis is a progressive, systemic, skeletal disorder characterized by low bone mass, an increase in bone fragility, and susceptibility to fracture. In Germany the estimated prevalence of osteoporosis (based on ICD10-GM [International Classification of Diseases, 10th revision, German Modification] code M80.*/M81.*) was 4.4% in 2016, affecting approximately 3.63 million patients, 83% of whom were female [2, 3]. It is estimated that ~ 334,000 osteoporosis patients in Germany suffered new vertebral or hip/ femur fractures in 2016 [3]. Fragility fractures are associated with chronic pain, disability, reduced quality of life and increased mortality [1, 5,6,7,8,9]. In Germany, they accounted for approximately €11 billion in healthcare-related costs and a loss of over 300,000 quality-adjusted life years in 2017 [10]. The related quality-adjusted life year losses are expected to rise by 22.4% [10]

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