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Magnitude of fragility fracture risk in the very old—are we meeting their needs? The Newcastle 85+ Study

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Abstract

Summary

Fractures due to osteoporosis are common in older people. This study assessed the management of osteoporosis in a group of 85-year-olds and found both assessment and current treatment to be suboptimal.

Introduction

Fragility fractures are a major cause of excess mortality, substantial morbidity, and health and social service expenditure in older people. However, much less is known about fracture risk and its management in the very old, despite this being the fastest growing age group of our population.

Methods

Cross-sectional analysis of people who reached the age of 85 during the year of 2006 was carried out. Data were gathered by general practice record review (GPRR) and a multidimensional health assessment (MDHA).

Results

Seven hundred thirty-nine individuals were recruited. Mean age was 85.55 years (SD 0.44), and 60.2 % were female; 33.7 % (n = 249) had experienced one or more fragility fractures (F 45.2 % vs M 16.3 % p < 0.001); in total, 332 fractures occurred in these 249 individuals. A formal documented diagnosis of osteoporosis occurred in 12.4 %, and 38 % of individuals had experienced a fall in the last 12 months. When the fracture risk assessment tool (FRAX) and National Osteoporosis Guideline Group (NOGG) guidelines were applied, osteoporosis treatment would be recommended in 35.0 %, with a further 26.1 % identified as needing bone mineral density (BMD) measurement and 38.9 % not requiring treatment or BMD assessment. Women were more likely than men to need treatment (47.4 vs 16.3 %, p < 0.001, odds ratio (OR) 4.62 (3.22–5.63)) and measurement of BMD (40.0 vs 5.1 %, p < 0.001, OR 12.4 (7.13–21.6)). Of the 259 individuals identified as requiring treatment, only 74 (28.6 %) were on adequate osteoporosis treatment.

Conclusion

The prevalence of high fracture risk in the very old is much higher than the documented diagnosis of osteoporosis or the use of adequate treatments.

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Acknowledgments

The Newcastle 85+ Study has been funded by the Medical Research Council, Biotechnology and Biological Sciences Research Council and the Dunhill Medical Trust. Parts of the work have also been funded by the British Heart Foundation, Unilever Corporate Research, Newcastle University and North of England Commissioning Support Unit (formerly NHS North of Tyne, working on behalf of Newcastle PCT, North Tyneside PCT and Northumberland Care Trust). We acknowledge the operational support of North of England Commissioning Support Unit and of the local general practitioners and their staff. We thank the research nurses, laboratory technicians, data management and clerical team for outstanding work throughout, as well as many colleagues for their expert advice. Thanks are due especially to the study participants and, where appropriate, their families and carers.

Conflicts of interest

Rachel Duncan, Carol Jagger, Andrew Kingston, Eugene McCloskey, Joanna Collerton, Louise Robinson, Thomas BL Kirkwood and Fraser Birrell declare that they have no conflict of interest. Roger Francis is a member of the writing group of the National Osteoporosis Guideline Group (NOGG) and a Trustee of the National Osteoporosis Society. He has served on Advisory Boards for Merck, Sharp and Dohme, Proctor and Gamble, Novartis, Lilly and Servier, all of whom have marketed drug treatments for osteoporosis.

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Authors and Affiliations

  1. Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK

    R. Duncan & L. Robinson

  2. Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK

    R. M. Francis, C. Jagger, A. Kingston, J. Collerton & T. B. L. Kirkwood

  3. Academic Unit of Bone Metabolism, Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK

    E. McCloskey

  4. Institute of Cellular Medicine, Newcastle University, Cookson Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK

    F. Birrell

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  1. R. Duncan
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  2. R. M. Francis
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  3. C. Jagger
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  4. A. Kingston
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  5. E. McCloskey
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  6. J. Collerton
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  7. L. Robinson
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  8. T. B. L. Kirkwood
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  9. F. Birrell
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Corresponding author

Correspondence to R. Duncan.

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Duncan, R., Francis, R.M., Jagger, C. et al. Magnitude of fragility fracture risk in the very old—are we meeting their needs? The Newcastle 85+ Study. Osteoporos Int 26, 123–130 (2015). https://doi.org/10.1007/s00198-014-2837-8

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  • DOI: https://doi.org/10.1007/s00198-014-2837-8

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