Pattern of second osteoporotic fractures. A descriptive study in two tertiary care centers in Sri Lanka

Abstract

Introduction: Second osteoporotic fractures have higher morbidity and mortality than prior osteoporotic fractures.
 Materials and methods: A retrospective case series of patients admitted to two tertiary care hospitals with second osteoporotic fractures from April 2020 to March 2021 assessed demography, time since the first osteoporotic fracture, fracture locations, comorbidities, menopausal age, predisposing drugs and habits, parental history, fall risk, BMI, family support and treatment.
 Results: Fifty-four patients were studied. Forty-nine (90.7%) were females, Mean age was 75.8 years (57-95). Mean time since the first fracture was 3.67 years (3/12-12). Twenty-six (48.1% p 0.00) had second fracture within 2 years since first osteoporotic fracture. Major osteoporotic sites involved in 79.6% of first fractures and 85.1% of second fractures. Proximal femur was the predominantly involved major site in first (23/43 p 0.00007) and second (35/46 p 0.00) fractures. Females who had premature/early menopause were significantly associated with the second fracture before the age of 75 years (10/15 p 0.03) and with non-major site involvement (5/15 p 0.035). Forty-nine (90.7%) patients had fall risk. Forty-seven (87.03%) patients lived with their family. Only 2/54 had DEXA. Patients who were aware of their condition had better compliance for supplements (9/12 p 0.0003). Anti-osteoporotic agent was used by 3/54 patients.
 Discussion and Conclusion: Female gender, premature/early menopause and prior proximal femur fracture are the main risk factors for second osteoporotic fracture. Following all low energy fractures, immediate osteoporosis diagnostic work up with commencement of anti-osteoporotic regime accordingly and modification of fall risk are recommended to reduce the imminent risk of second osteoporotic fracture occurrence.