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Calcified Tissue International

, Volume 104, Issue 1, pp 102–114 | Cite as

OFELIA: Prevalence of Osteoporosis in Fragility Fracture Patients

  • Randi M. H. TeiEmail author
  • Cecilia H. Ramlau-Hansen
  • Oleguer Plana-Ripoll
  • Ole Brink
  • Bente L. Langdahl
Original Research
First Online:
  • 218 Downloads

Abstract

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.

Keywords

Osteoporosis Secondary fracture prevention Fracture risk assessment Screening 
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Notes

Acknowledgements

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.

Author Contributions

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.

Funding

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.

Ethical Approval

The study complies with the principles outlined in the Declaration of Helsinki. The study was approved by the Danish Data Protection Agency.

Informed Consent

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.

Supplementary material

223_2018_476_MOESM1_ESM.docx (25 kb)
Supplementary material 1 (DOCX 24 KB)
223_2018_476_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOCX 21 KB)

References

  1. 1.
    [Anonymous] (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650CrossRefGoogle Scholar
  2. 2.
    Center J, Eisman J (1997) The epidemiology and pathogenesis of osteoporosis. Baillière’s Clin Endocrinol Metab 11:23–62CrossRefGoogle Scholar
  3. 3.
    Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936CrossRefGoogle Scholar
  4. 4.
    Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24:393–406CrossRefGoogle Scholar
  5. 5.
    McLellan AR, Wolowacz SE, Zimovetz EA, Beard SM, Lock S, McCrink L, Adekunle F, Roberts D (2011) Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision (structured abstract). Osteoporos Int 22:2083–2098CrossRefGoogle Scholar
  6. 6.
    Mehrpour SR, Aghamirsalim MR, Sorbi R (2012) Are hospitalized patients with fragile fractures managed properly in relation to underlying osteoporosis? J Clin Rheumatol 18:122–124CrossRefGoogle Scholar
  7. 7.
    Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778CrossRefGoogle Scholar
  8. 8.
    Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305CrossRefGoogle Scholar
  9. 9.
    McCloskey EV, Harvey NC, Kanis JA (2015) Can we treat to target in osteoporosis?. Int J Clin Rheumatol 10:01CrossRefGoogle Scholar
  10. 10.
    Boonen S, Reginster J, Kaufman J, Lippuner K, Zanchetta J, Langdahl B, Rizzoli R, Lipschitz S, Dimai HP, Witvrouw R, Eriksen E, Brixen K, Russo L, Claessens F, Papanastasiou P, Antunez O, Su G, Bucci-Rechtweg C, Hruska J, Incera E, Vanderschueren D, Orwoll E (2012) Fracture risk and zoledronic acid therapy in men with osteoporosis. N Engl J Med 367:1714–1723CrossRefGoogle Scholar
  11. 11.
    Cummings SR, Martin JS, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765CrossRefGoogle Scholar
  12. 12.
    Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822CrossRefGoogle Scholar
  13. 13.
    Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster J, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mellström D, Oefjord ES, Marcinowska-Suchowierska E, Salmi J, Mulder H, Halse J, Sawicki AZ, Mitlak BH (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441CrossRefGoogle Scholar
  14. 14.
    Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348:1535–1541CrossRefGoogle Scholar
  15. 15.
    Langdahl BL, Silverman S, Fujiwara S, Saag K, Napoli N, Soen S, Enomoto H, Melby TE, Disch DP, Marin F, Krege JH (2018) Real-world effectiveness of teriparatide on fracture reduction in patients with osteoporosis and comorbidities or risk factors for fractures: integrated analysis of 4 prospective observational studies. Bone 116:58–66CrossRefGoogle Scholar
  16. 16.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739CrossRefGoogle Scholar
  17. 17.
    Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382CrossRefGoogle Scholar
  18. 18.
    Wu C-, Kao I-, Hung W-, Lin S-, Liu H-, Hsieh M-, Bagga S, Achra M, Cheng T, Yang R (2018) Economic impact and cost-effectiveness of fracture liaison services: a systematic review of the literature. Osteoporos Int 29:1227–1242CrossRefGoogle Scholar
  19. 19.
    Marsh D, Åkesson K, Beaton DE, Bogoch ER, Boonen S, Brandi M-, McLellan AR, Mitchell PJ, Sale JEM, Wahl DA (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22:2051–2065CrossRefGoogle Scholar
  20. 20.
    McLellan AR, Gallacher SJ, Fraser M, McQuillian C (2003) The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 14:1028–1034CrossRefGoogle Scholar
  21. 21.
    United Kingdom, National Osteoporosis Society. http://www.nos.org.uk. Accessed 31 Aug 2018
  22. 22.
    van Geel TACM, Bliuc D, Geusens PPM, Center JR, Dinant G, Tran T, van den Bergh JPW, McLellan AR, Eisman JA (2018) Reduced mortality and subsequent fracture risk associated with oral bisphosphonate recommendation in a fracture liaison service setting: a prospective cohort study. PLoS ONE 13(6):e0198006CrossRefGoogle Scholar
  23. 23.
    Mitchell PJ (2013) Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep 11:52–60CrossRefGoogle Scholar
  24. 24.
    Åkesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C (2013) Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int 24:2135–2152CrossRefGoogle Scholar
  25. 25.
    Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporos Int 23(5):1623–1629CrossRefGoogle Scholar
  26. 26.
    Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27:2039–2046CrossRefGoogle Scholar
  27. 27.
    Hansen L, Petersen KD, Eriksen SA, Langdahl BL, Eiken PA, Brixen K, Abrahamsen B, Jensen JB, Harsløf T, Vestergaard P (2015) Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int 26(2):513–519CrossRefGoogle Scholar
  28. 28.
    Bliuc D, Ong CR, Eisman JA, Center JR (2005) Barriers to effective management of osteoporosis in moderate and minimal trauma fractures: a prospective study. Osteoporos Int 16:977–982CrossRefGoogle Scholar
  29. 29.
    Kanis JA, McCloskey EV, Harvey NC, Johansson H, Leslie WD (2015) Intervention thresholds and the diagnosis of osteoporosis. J Bone Miner Res 30:1747–1753CrossRefGoogle Scholar
  30. 30.
    Fracture risk assessment tool FRAX. http://www.shef.ac.uk/FRAX. Accessed 31 Aug 2018
  31. 31.
    Vestergaard P, Rejnmark L, Mosekilde L (2006) Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark. Scand J Public Health 34:371–377CrossRefGoogle Scholar
  32. 32.
    Pedersen MA, Gregersen M, Langdahl BL, Damsgaard EMS (2014) Frail elderly hip fracture patients and vitamin D. J Gerontol Geriatr Res 3(5):180Google Scholar
  33. 33.
    Abrahamsen B, Vestergaard P (2010) Declining incidence of hip fractures and the extent of use of anti-osteoporotic therapy in Denmark 1997–2006. Osteoporos Int 21:373–380CrossRefGoogle Scholar
  34. 34.
    Clunie G, Stephenson S (2008) Implementing and running a fracture liaison service: an integrated clinical service providing a comprehensive bone health assessment at the point of fracture management. J Orthop Nurs 12:159–165CrossRefGoogle Scholar
  35. 35.
    Osteoporosis Canada. http://www.osteoporosis.ca. Accessed 31 Aug 2018
  36. 36.
    Löffman O, Hallberg I, Berglund K, Wahlström O, Kartous L, Rosenqvist AM, Larsson L, Toss G (2007) Women with low-energy fracture should be investigated for osteoporosis. Acta Orthop 78:813–821CrossRefGoogle Scholar
  37. 37.
    Åstrand J, Thorngren KG, Tägil M (2006) One fracture is enough!: experience with a prospective and consecutive osteoporosis screening program with 239 fracture patients. Acta Orthop 77:3–8CrossRefGoogle Scholar
  38. 38.
    Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the national osteoporosis risk assessment. JAMA 286:2815–2822CrossRefGoogle Scholar
  39. 39.
    Svejme O, Ahlborg H, Nilsson J, Karlsson M (2012) Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women. BJOG: Int J Obstet Gynaecol 119:810–816CrossRefGoogle Scholar
  40. 40.
    Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefGoogle Scholar
  41. 41.
    Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018CrossRefGoogle Scholar
  42. 42.
    De Laet C, Kanis JA, Odén A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ 3rd, Meunier PJ, Pols HAP, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338CrossRefGoogle Scholar
  43. 43.
    Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, Cauley JA, Compston JE, Dawson-Hughes B, El-Hajj Fuleihan G, Johansson H, Leslie WD, Lewiecki EM, Luckey M, Oden A, Papapoulos SE, Poiana C, Rizzoli R, Wahl DA, McCloskey EV (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22:2395–2411CrossRefGoogle Scholar
  44. 44.
    Eekman DA, van Helden SH, Huisman AM, Verhaar HJJ, Bultink IEM, Geusens PP, Lips P, Lems WF (2014) Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporos Int 25:701–709CrossRefGoogle Scholar
  45. 45.
    Langdahl BL (2017) Osteoporosis in premenopausal women. Curr Opin Rheumatol 29:410–415CrossRefGoogle Scholar
  46. 46.
    Ross S, Samuels E, Gairy K, Iqbal S, Badamgarav E, Siris E (2011) A meta-analysis of osteoporotic fracture risk with medication nonadherence. Value Health 14:571–581CrossRefGoogle Scholar
  47. 47.
    Kothawala P, Badamgarav E, Ryu S, Miller RM, Halbert RJ (2007) Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc 82:1493–1501CrossRefGoogle Scholar
  48. 48.
    Huas D, Debiais F, Blotman F, Cortet B, Mercier F, Rousseaux C, Berger V, Gaudin A, Cotté F (2010) Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment. BMC Womens Health 10:26CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Endocrinology and Internal MedicineAarhus University HospitalAarhus NDenmark
  2. 2.Section for Epidemiology, Department of Public HealthAarhus UniversityAarhus CDenmark
  3. 3.National Center for Register-based ResearchAarhus UniversityAarhus CDenmark
  4. 4.Department of Orthopedic Surgery (E)Aarhus University HospitalAarhus NDenmark

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