Refracture and mortality following hospitalization for severe osteoporotic fractures: The Fractos Study.

Christian Roux,Florence Tubach,Emese Toth,Anne Crochard,Laure Perrin,Frédérique Maurel,Thierry Thomas,Geoffray Bizouard,Julien Paccou,Magali Lemaitre

doi:10.1002/jbm4.10507

Abstract

ABSTRACTSevere osteoporotic fractures (hip, proximal humerus, pelvic, vertebral and multiple rib fractures) carry an increased risk of mortality. This retrospective cohort study in the French national healthcare database aimed to estimate refracture and mortality rates after severe osteoporotic fractures at different sites, and to identify mortality‐related variables. A total of 356,895 patients hospitalized for severe osteoporotic fracture between 2009 and 2014 inclusive were analyzed. The cohort was followed for 2 to 8 years up to the study end or until the patient died. Data were extracted on subsequent hospitalizations, refracture events, treatments, comorbidities of interest and survival. Time to refracture and survival were described using Kaplan‐Meier analysis by site of fracture and overall. Mortality risk factors were identified using a Cox model. Hip fractures accounted for 60.4% of the sample (N = 215,672). In the 12 months following fracture, 58,220 patients (16.7%) received a specific osteoporosis treatment, of whom 21,228 were previously treatment‐naïve. The 12‐month refracture rate was 6.3% (95% confidence interval [CI], 6.2%–6.3%), ranging from 4.0% (95% CI, 3.7%–4.3%) for multiple rib fractures to 7.8% (95% CI, 7.5%–8.1%) for pelvic fractures. Twelve‐month all‐cause mortality was 12.8% (95% CI, 12.7%–12.9%), ranging from 5.0% (95% CI, 4.7%–5.2%) for vertebral fractures to 16.6% (95% CI, 16.4%–16.7%) for hip fractures. Osteoporosis‐related mortality risk factors included fracture site, previous osteoporotic fracture (hazard ratio 1.21; 95% CI, 1.18–1.23), hip refracture (1.74; 95% CI, 1.71–1.77), and no prior osteoporosis treatment (1.24; 95% CI, 1.22–1.26). Comorbid cancer (3.15; 95% CI, 3.09–3.21) and liver disease (2.54; 95% CI, 2.40–2.68) were also strongly associated with mortality. In conclusion, severe osteoporotic fractures, including certain non‐hip nonvertebral fractures, carry a high burden in terms of mortality and refracture risk. However, most patients received no anti‐osteoporotic treatment. The findings emphasize the importance of better management of patients with severe fractures, and of developing effective strategies to reduce fracture risk in patients with osteoporosis. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Highlights

Osteoporotic fractures are a major source of disability, loss of autonomy and reduced quality of life.[1,2,3,4,5,6] Two major epidemiological features of osteoporosis highlight the view that this disease is becoming an important threat to the elderly population and generate an even heavier burden to health care
It should be noted that the present definition of ‘severe osteoporotic fractures’ is not identical as that proposed by the International Osteoporosis Foundation for ‘major osteoporotic fractures’ which includes distal forearm fractures, but excludes pelvic and rib fractures [23]
The FRACTOS study demonstrates that, in a study population of over 350,000 eligible patients hospitalised for a severe osteoporotic fracture, the mortality risk is two to three-fold higher than the refracture risk, the two outcomes are not independent

Summary

Introduction

Osteoporotic fractures are a major source of disability, loss of autonomy and reduced quality of life.[1,2,3,4,5,6] Two major epidemiological features of osteoporosis highlight the view that this disease is becoming an important threat to the elderly population and generate an even heavier burden to health care. While the average risk of sustaining a fracture is twofold higher in patients with prevalent fractures,(12) there is a growing body of evidence that fractures cluster in time, with a high risk of refracture in the two to three years following a fracture, decreasing thereafter. This temporary increase defines the imminent fracture risk,(13) which can have implications for patient management. During this high-risk period, osteoporosis has a major impact on refracture, utility loss and mortality,(1418) depending on features such as age,(14) comorbidities and the location of the fracture.[19]

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Conclusion