Abstract
Summary
This study describes the characteristics of 337 patients seen by the fracture liaison service of the Amiens University Hospital for at least two osteoporotic fractures between 2009 and 2019. Results showed that recurrent fracture occurs rapidly after the index fracture. Rheumatological and therapeutic managements are not sufficient, mainly because of cognitive disorders or patients’ refusal.
Purpose
The aim of this study was to describe the characteristics of patients taken in charge by a fracture liaison service and sustaining a recurrent osteoporotic fracture.
Methods
This was a retrospective and monocentric study based on the dataset of patients included in the FLS of the Department of Rheumatology of the Amiens University Hospital. To be included in the study cohort, patients must have had at least two consecutive osteoporotic fractures between January 2009 and December 2019.
Results
Three hundred thirty-seven patients were included. The mean age at index fracture was 77.3 ± 12.5 years. Eighty-four percent of the patients were women. 89.3% of the patients had a Charlson comorbidity index between 1 and 4. Nearly half of the patients had cognitive disorders. Femoral neck was the most frequent site for both index and recurrent fractures. Thirty-seven percent of patients benefited from a consultation in Rheumatology after their index fracture. The main reasons for the lack of follow-up were cognitive disorders and patient rejection.
Conclusion
Our study showed that recurrent fracture occurs rapidly after the index fracture and that rheumatological and therapeutic managements are not sufficient, mainly because of cognitive disorders or patients’ refusal impairing the patients to benefit from specialized management.
References
van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68(1):99–102. https://doi.org/10.1136/ard.2008.092775
Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E et al (2017) Imminent risk of fracture after fracture. Osteoporos Int J 28(3):775–780
Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O et al (2019) Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int 30(3):601–609
Kanis JA, Johansson H, Odén A, Harvey NC, Gudnason V, Sanders KM et al (2018) Characteristics of recurrent fractures. Osteoporos Int 29(8):1747–1757
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(5):293–305. https://doi.org/10.1016/j.semarthrit.2005.11.001
Briot K, Roux C, Thomas T, Blain H, Buchon D, Chapurlat R et al (2018) Actualisation 2018 des recommandations françaises du traitement de l’ostéoporose post-ménopausique. Rev Rhum 85(5):428–440
Roux C, Thomas T, Paccou J, Bizouard G, Crochard A, Toth E et al (2021) Refracture and mortality following hospitalization for severe osteoporotic fractures: The fractos study. JBMR Plus 5(7). https://doi.org/10.1002/jbm4.10507
Bynum JPW, Bell JE, Cantu RV, Wang Q, McDonough CM, Carmichael D et al (2016) Second fractures among older adults in the year following hip, shoulder, or wrist fracture. Osteoporos Int 27(7):2207–2215
Ganda K, Schaffer A, Seibel MJ (2015) Predictors of re-fracture amongst patients managed within a secondary fracture prevention program: a 7-year prospective study. Osteoporos Int 26:543–551. https://doi.org/10.1007/s00198-014-2880-5
Eekman DA, van Helden SH, Huisman AM, Verhaar HJJ, Bultink IEM, Geusens PP et al (2014) Optimizing fracture prevention: the fracture liaison service, an observational study. Osteoporos Int 25(2):701–709
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in U.S. patients between 2002 and 2011. J Bone Miner Res 29(9):1929–1937
Briançon D, de Gaudemar JB, Forestier R (2004) Management of osteoporosis in women with peripheral osteoporotic fractures after 50 years of age: a study of practices. Jt. Bone Spine 71(2):128–130. https://doi.org/10.1016/S1297-319X(03)00060-5
Malochet-Guinamand S, Chalard N, Billault C, Breuil N, Ristori JM, Schmidt J (2005) Osteoporosis treatment in postmenopausal women after peripheral fractures: impact of information to general practitioners. Jt. Bone Spine 72(6):562–566
Dehamchia-Rehailia N, Ursu D, Henry-Desailly I, Fardellone P, Paccou J (2014) Secondary prevention of osteoporotic fractures: evaluation of the Amiens University Hospital’s fracture liaison service between January 2010 and December 2011. Osteoporos Int 25(10):2409–2416. https://doi.org/10.1007/s00198-014-2774-6
Kannegaard PN, van der Mark S, Eiken P, Abrahamsen BO (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age ageing 39(2):203–209
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(12):1028–1034
Huntjens KMB, Van Geel TACM, Blonk MC, Hegeman JH, Van der Elst M, Willems P, Van Helden SH (2011) Implementation of osteoporosis guidelines: a survey of five large fracture liaison services in the Netherlands. Osteoporosis Int 22:2129–2135
Prieto-Alhambra D, Judge A, Arden NK, Cooper C, Lyles KW, Javaid MK (2014) Fracture prevention in patients with cognitive impairment presenting with a hip fracture: secondary analysis of data from the HORIZON Recurrent Fracture Trial. Osteoporos Int 25(1):77–83
Greenspan S, Nace D, Perera S, Ferchak M, Fiorito G, Medich D et al (2012) Lessons learned from an osteoporosis clinical trial in frail long-term care residents. Clin Trials 9(2):247–256
Gehlbach S, Saag KG, Adachi JD, Hooven FH, Flahive J, Boonen S et al (2012) Previous fractures at multiple sites increase the risk for subsequent fractures: The global longitudinal study of osteoporosis in women. J Bone Miner Res 27(3):645–653
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Rights and permissions
About this article
Cite this article
Doussiere, M., Jesson, C., Diep, L. et al. Clinical and biological parameters associated with fracture recurrence according to fracture liaison service dataset. Osteoporos Int 34, 1977–1982 (2023). https://doi.org/10.1007/s00198-023-06868-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-023-06868-7