OFELIA: Prevalence of Osteoporosis in Fragility Fracture Patients
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Worldwide, a care gap has been recognized between presenting with a fracture and prevention of the next fracture. Fracture Liaison Service is the most cost-effective method to close this gap, but its implementation is sparse in the Nordic countries. To assess the need for a fracture prevention program, the primary aim of this study was to estimate the prevalence of osteoporosis in patients treated for fragility fractures at Aarhus University Hospital, Denmark. Secondary aims were to identify clinical risk factors associated with osteoporosis and the up-take of anti-osteoporosis treatment. The study was conducted as a cross-sectional study and patients aged 18+ years were consecutively identified over a 12 months period. Of 1164 identified patients, 832 were included and 794 (70% women, 66% aged ≥ 50 years) patients completed the study. Bone mineral density was measured by DXA and information about clinical risk factors were obtained. The overall prevalence of osteoporosis in this cohort was 14.9%, increasing to 20.3% in patients ≥ 50 years (22.9% in women, 9.6% in men). In addition to age above 50 years, female sex, low BMI, and early menopause were significantly associated with osteoporosis. At 3-years follow-up in patients diagnosed with osteoporosis, 95% of patients who initiated anti-osteoporosis treatment after their fracture were still adherent to treatment. Given that osteoporosis was demonstrated in one in five fragility fracture patients above 50 years, OFELIA stresses the need for implementation of a program aiming at securing appropriate investigation and treatment of osteoporosis in patients presenting a fragility fracture.
KeywordsOsteoporosis Secondary fracture prevention Fracture risk assessment Screening
We wish to express our gratitude to all participants in OFELIA for their willingness to make this study possible. To our colleagues at the Department of orthopedic surgery (E) and the Department emergency and acute medicine (FAA) at Aarhus University Hospital (AUH) for identifying fracture patients for this study. Also, many thanks to the staff at The Osteoporosis Clinic, AUH for their great work performing the DXAs.
Study design and conduct: RT, BL and OB. Data collection: RT. Data analysis and interpretation: RT, CR, OR, OB and BL. Drafting manuscript: RT and BL. Revising manuscript content: CR, OR and OB. Approving final version of manuscript: RT, CH, OR, OB and BL. RT takes responsibility for the integrity of the data analysis, has full control of all primary data and agrees to allow the journal to review data if requested.
For financial support, we wish to thank the Health Research Fund of Central Denmark Region, Aarhus University Hospital (“Spydspidspuljen”), Department of Endocrinology and Internal Medicine (MEA), AUH and the Danish Osteoporosis Society.
Compliance with Ethical Standards
Conflict of interest
Bente L. Langdahl has received honoraria for consulting and lecturing for Amgen, Merck, UCB, and TEVA and received research grants from Amgen and Novo Nordisk. Randi M. H. Tei, Cecilia H. Ramlau-Hansen, Oleguer Plana-Ripoll, Ole Brink have no conflicts of interests.
The study complies with the principles outlined in the Declaration of Helsinki. The study was approved by the Danish Data Protection Agency.
All informants were informed that they could withdraw their participation at any time before or during the interview without any consequences for their further fracture treatment and follow-up. The study was approved by the Danish Data Protection Agency (J. No. 2007-58-0016). We submitted the protocol to review by the Central Denmark Region Committees on Health Research Ethics, but they found that the study procedures were in accordance to the Danish osteoporosis guidelines and non-interventional. Therefore, the study did not need formal ethical approval and did not need informant consent. Nevertheless, in agreement with good clinical practice we collected informed written consent from all participants.
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