The burden and undertreatment of fragility fractures among senior women
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Using a large population database, we showed that fragility fractures were highly prevalent in senior women and were associated with significant physical disability. However, treatment rates were low because osteoporosis treatment was not prescribed or not agreed to by the majority of women with prevalent fragility fractures.
The purpose of the study is to estimate prevalence of fragility fractures (FF), risk factors, and treatment rates in senior women and to assess impact of FF on physical function and quality of life.
Women aged 65 years and older from the EpiReumaPt study (2011–2013) were evaluated. Rheumatologists collected data regarding FF, clinical risk factors for fractures, and osteoporosis (OP) treatment. Health-related quality of life (EQ5D) and physical function (HAQ) were analyzed. Peripheral dual-energy X-ray absorptiometry was performed. FF was defined as any self-reported low-impact fracture that occurred after 40 years of age. Prevalence estimates of FF were calculated.
Among 3877 subjects evaluated in EpiReumaPt, 884 were senior women. The estimated prevalence of FF was 20.7%. Lower leg was the most frequent fracture site reported (37.8%) followed by wrist (18.6%). Only 7.1% of the senior women reporting a prevalent FF were under treatment for OP, and 13.9% never had treatment. OP treatment was not prescribed in 47.7% of FF women, and 23.4% refused treatment. Age (OR = 2.46, 95% CI 1.11–5.47), obesity (OR = 2.05, 95% CI 1.14–3.70), and low wrist BMD (OR = 2.29; 95% CI 1.20, 4.35; p = 0.012) were positively associated with prevalent FF. A significantly higher proportion of women in the lowest quintile of wrist bone mineral density reported FF (OR = 2.29, 95% CI 1.20–4.35). FF were associated with greater physical disability (β = 0.33, 95% CI 0.13–0.51) independent of other comorbidities.
FF was frequently reported among senior women as an important cause of physical disability. However, the prevalence of OP treatment was low, which constitutes a public health problem in this vulnerable group.
KeywordsFragility fractures Osteoporosis treatment Epidemiology Women
The EpiReumaPt Study Group acknowledges the invaluable input from Sofia Ramiro, MD, PhD; Pedro Machado, MD, PhD; Henrique de Barros, MD, PhD; João Eurico da Fonseca, MD, PhD; José António Pereira da Silva, MD, PhD; Francisco George, MD; Rui André Santos, MD; Luís Maurício Santos, MD; José Carlos Romeu, MD; Faculdade de Medicina da Universidade de Coimbra, Faculdade de Medicina da Universidade de Lisboa, Faculdade de Medicina da Universidade Porto, Liga Portuguesa Contra as Doenças Reumáticas, Associações de doentes com doenças reumáticas, Administrações Regionais de Saúde (Norte, Centro, Lisboa & Vale do Tejo, Alentejo and Algarve), Governo Regional da Madeira, Governo Regional dos Açores, Associação Nacional de Freguesias, Associação Nacional dos Municípios Portugueses, Câmara Municipal de Lisboa, Centros de Saúde, and Centro Hospitalar do Porto—Hospital de São João.
The study was supported by unrestricted grants from Direcção-Geral da Saúde, Fundação Calouste Gulbenkian, Fundação Champalimaud, Fundação AstraZeneca, Abbvie, Merck, Sharp & Dohme, Pfizer, Roche, Servier, Bial, D3A Medical Systems, Happybrands, Center de Medicina Laboratorial Germano de Sousa, Clínica Médica da Praia da Vitória, CAL-Clínica, Galp Energia, Açoreana Seguros, and individual rheumatologists.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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