Skip to main content

Advertisement

SpringerLink
Log in

Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Introduction

Imminent fracture risk, or fractures within 2 years of an initial fracture, is a pressing issue worldwide. Hong Kong is a city with one of the longest life expectancies. The concern of fragility fractures and the imminent risk of a subsequent fracture is becoming a top priority. The objective of this study was to present the epidemiology of incident fragility fractures of all public acute hospitals and the imminent risk of a subsequent fracture in Hong Kong.

Methodology

This was a retrospective population-based analysis. Patient records from all acute hospitals in Hong Kong from 1 January 2004 to 31 December 2018 were retrieved for patients ≥ 50 years of age with hip, distal radius, or proximal humerus fractures. Secondary fractures and falls were identified in the subsequent 5 years. Post hoc analysis in recent 2013–2018 period was performed. Overall survival (re-fracture incidence) on age subgroups using Kaplan survival analysis and variables was compared using the log-rank test. Cox proportional hazard regressions, obtaining the hazard ratios (HR) and their respective 95% confidence intervals (CI), were used.

Results

There is an overall increasing trend of fragility fractures (hip, distal radius, proximal humerus) from 5596 in 2004 to 8465 in 2018. The average cumulative imminent risk of fractures from recent 5 years is 3.87% at 1 year and 6.50% at 2 years. 49.5% of the patients with a secondary fracture occurred within 2 years since the initial major fragility fracture. Post hoc analysis in recent 2013–2018 period (N = 7039) showed male patients were 1.21 times more likely to have further fractures with time (HR = 1.21 (1.02, 1.45), p = 0.03) compared with female patients. Patients over age 95 were 2.01 times higher than patients of age under 75 to have further fracture over time.

Conclusions

Following an initial fracture, prompt treatment strategies should be adopted to avoid imminent risk of fractures. This window of opportunity in the first 2 years is a golden period to treat osteoporosis and prevent falls. Our post hoc analysis has shown that male patients and patients older than 95 are at even higher risk. Clinicians and allied healthcare professionals should be alert on these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Roux C, Briot K (2017) Imminent fracture risk. Osteoporos Int 28(6):1765–1769

    Article  CAS  Google Scholar 

  2. Johansson H, Siggeirsdottir K, Harvey NC, Oden A, Gudnason V, McCloskey E et al (2017) Imminent risk of fracture after fracture. Osteoporos Int 28(3):775–780

    Article  CAS  Google Scholar 

  3. Banefelt J, Akesson KE, Spangeus A, Ljunggren O, Karlsson L, Strom O et al (2019) Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int 30(3):601–609

    Article  CAS  Google Scholar 

  4. Rachner TD, Khosla S, Hofbauer LC (2011) Osteoporosis: now and the future. Lancet. 377(9773):1276–1287

    Article  CAS  Google Scholar 

  5. Sozen T, Ozisik L, Basaran NC (2017) An overview and management of osteoporosis. Eur J Rheumatol 4(1):46–56

    Article  Google Scholar 

  6. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733

    Article  CAS  Google Scholar 

  7. Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA. 297(4):387–394

    Article  CAS  Google Scholar 

  8. Weaver J, Sajjan S, Lewiecki EM, Harris ST, Marvos P (2017) Prevalence and cost of subsequent fractures among U.S. patients with an incident fracture. J Manag Care Spec Pharm 23(4):461–471

    PubMed  Google Scholar 

  9. Centre for Health Protection DoH, The Government of the Hong Kong Special Administrative Region. Life expectancy at birth (male and female), 1971 - 2017 2019 [Available from: https://www.chp.gov.hk/en/statistics/data/10/27/111.html

  10. Cheung MY, Ho AW, Wong SH (2018) Post-fracture care gap: a retrospective population-based analysis of Hong Kong from 2009 to 2012. Hong Kong Med J 24(6):579–583

    CAS  PubMed  Google Scholar 

  11. Wong RMY, Wong H, Zhang N, Chow SKH, Chau WW, Wang J, Chim YN, Leung KS, Cheung WH (2019) The relationship between sarcopenia and fragility fracture-a systematic review. Osteoporos Int 30(3):541–553

    Article  CAS  Google Scholar 

  12. Wu CH, Tu ST, Chang YF, Chan DC, Chien JT, Lin CH, Singh S, Dasari M, Chen JF, Tsai KS (2018) Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone. 111:92–100

    Article  Google Scholar 

  13. Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, Curtis JR (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30(1):79–92

    Article  CAS  Google Scholar 

  14. Wong RMY, Choy MHV, Li MCM, Leung KS, S KHC, Cheung WH et al (2018) A systematic review of current osteoporotic metaphyseal fracture animal models. Bone Joint Res 7(1):6–11

    Article  CAS  Google Scholar 

  15. Cheung NT, Fung KW, Wong KC, Cheung A, Cheung J, Ho W, Cheung C, Shung E, Fung V, Fung H (2001) Medical informatics--the state of the art in the Hospital Authority. Int J Med Inform 62(2–3):113–119

    Article  CAS  Google Scholar 

  16. Fung V, Cheung NT, Ho E, Cheung C, Chan H, Tsang K, Cheung J, Ho W, Lau M, Hung V, Wong A, Tong A, Wong WN, Sek A (2007) Building a womb-to-tomb health record in Hong Kong--an application of information architecture. Stud Health Technol Inform 129(Pt 1):474–477

    PubMed  Google Scholar 

  17. Sing CW, Woo YC, Lee ACH, Lam JKY, Chu JKP, Wong ICK, Cheung CL (2017) Validity of major osteoporotic fracture diagnosis codes in the Clinical Data Analysis and Reporting System in Hong Kong. Pharmacoepidemiol Drug Saf 26(8):973–976

    Article  Google Scholar 

  18. Kendler DL, Bauer DC, Davison KS, Dian L, Hanley DA, Harris ST et al (2016) Vertebral fractures: clinical importance and management. Am J Med 129(2):221–e1–10

    Article  Google Scholar 

  19. Fink HA, Milavetz DL, Palermo L, Nevitt MC, Cauley JA, Genant HK, Black DM, Ensrud KE (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 20(7):1216–1222

    Article  Google Scholar 

  20. Handoll HH, Keding A, Corbacho B, Brealey SD, Hewitt C, Rangan A (2017) Five-year follow-up results of the PROFHER trial comparing operative and non-operative treatment of adults with a displaced fracture of the proximal humerus. Bone Joint J 99-B(3):383–392

    Article  CAS  Google Scholar 

  21. Williamson S, Landeiro F, McConnell T, Fulford-Smith L, Javaid MK, Judge A, Leal J (2017) Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int 28(10):2791–2800

    Article  CAS  Google Scholar 

  22. Leung KS, Yuen WF, Ngai WK, Lam CY, Lau TW, Lee KB et al (2017) How well are we managing fragility hip fractures? A narrative report on the review with the attempt to set up a Fragility Fracture Registry in Hong Kong. Hong Kong Med J 23(3):264–271

    CAS  PubMed  Google Scholar 

  23. Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–127

    Article  Google Scholar 

  24. Wu CH, Kao IJ, Hung WC, Lin SC, Liu HC, Hsieh MH, Bagga S, Achra M, Cheng TT, Yang RS (2018) Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature. Osteoporos Int 29(6):1227–1242

    Article  Google Scholar 

  25. International Osteoporosis Foundation.2013 Epidemiology, costs, and burden of osteoporosis in Hong Kong The Asia Pacific Regional Audit.

  26. Boudou L, Gerbay B, Chopin F, Ollagnier E, Collet P, Thomas T (2011) Management of osteoporosis in fracture liaison service associated with long-term adherence to treatment. Osteoporos Int 22(7):2099–2106

    Article  CAS  Google Scholar 

  27. Bonanni S, Sorensen AA, Dubin J, Drees B (2017) The role of the Fracture Liaison Service in osteoporosis care. Mo Med 114(4):295–298

    PubMed  PubMed Central  Google Scholar 

  28. Dreinhofer KE, Mitchell PJ, Begue T, Cooper C, Costa ML, Falaschi P et al (2018) A global call to action to improve the care of people with fragility fractures. Injury. 49(8):1393–1397

    Article  CAS  Google Scholar 

  29. Berry SD, Miller RR (2008) Falls: epidemiology, pathophysiology, and relationship to fracture. Curr Osteoporos Rep 6(4):149–154

    Article  Google Scholar 

  30. Sherrington C, Tiedemann A (2015) Physiotherapy in the prevention of falls in older people. Aust J Phys 61(2):54–60

    Google Scholar 

  31. Steihaug OM, Gjesdal CG, Bogen B, Kristoffersen MH, Lien G, Ranhoff AH (2017) Sarcopenia in patients with hip fracture: a multicenter cross-sectional study. PLoS One 12(9):e0184780

    Article  Google Scholar 

  32. Hong W, Cheng Q, Zhu X, Zhu H, Li H, Zhang X, Zheng S, du Y, Tang W, Xue S, Ye Z (2015) Prevalence of sarcopenia and its relationship with sites of fragility fractures in elderly Chinese men and women. PLoS One 10(9):e0138102

    Article  Google Scholar 

  33. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet. 359(9319):1761–1767

    Article  Google Scholar 

  34. Kim SH, Szabo RM, Marder RA (2012) Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008. Arthritis Care Res 64(3):407–414

    Article  Google Scholar 

Download references

Funding

This study was financially supported by the Knowledge Transfer Fund 2019, the Chinese University of Hong Kong (Re: KPF19HKLF14).

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, 5/F, Lui Che Woo Clinical Sciences Building, Shatin, New Territories, Hong Kong SAR, China

    Ronald Man Yeung Wong, Wing Tung Ho, Law Sheung Wai, Wai Wang Chau, Kwoon-Ho Simon Chow & Wing-Hoi Cheung

  2. Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong SAR, China

    Wilson Li

Authors
  1. Ronald Man Yeung Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wing Tung Ho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Law Sheung Wai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wilson Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wai Wang Chau
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kwoon-Ho Simon Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wing-Hoi Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wing-Hoi Cheung.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, R.M.Y., Ho, W.T., Wai, L.S. et al. Fragility fractures and imminent fracture risk in Hong Kong: one of the cities with longest life expectancies. Arch Osteoporos 14, 104 (2019). https://doi.org/10.1007/s11657-019-0648-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-019-0648-4

Keywords

Search

Navigation