Skip to main content
SpringerLink
Log in

OFELIA: Prevalence of Osteoporosis in Fragility Fracture Patients

  • Original Research
  • Published:
Calcified Tissue International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. [Anonymous] (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650

    Article  Google Scholar 

  2. Center J, Eisman J (1997) The epidemiology and pathogenesis of osteoporosis. Baillière’s Clin Endocrinol Metab 11:23–62

    Article  CAS  Google Scholar 

  3. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  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 24:393–406

    Article  CAS  PubMed  Google Scholar 

  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 22:2083–2098

    Article  CAS  PubMed  Google Scholar 

  6. Mehrpour SR, Aghamirsalim MR, Sorbi R (2012) Are hospitalized patients with fragile fractures managed properly in relation to underlying osteoporosis? J Clin Rheumatol 18:122–124

    Article  PubMed  Google Scholar 

  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 15:767–778

    Article  CAS  PubMed  Google Scholar 

  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 35:293–305

    Article  CAS  PubMed  Google Scholar 

  9. McCloskey EV, Harvey NC, Kanis JA (2015) Can we treat to target in osteoporosis?. Int J Clin Rheumatol 10:01

    Article  CAS  Google Scholar 

  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 367:1714–1723

    Article  CAS  PubMed  Google Scholar 

  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 361:756–765

    Article  CAS  Google Scholar 

  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 356:1809–1822

    Article  CAS  Google Scholar 

  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 344:1434–1441

    Article  CAS  Google Scholar 

  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 348:1535–1541

    Article  CAS  PubMed  Google Scholar 

  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 116:58–66

    Article  CAS  PubMed  Google Scholar 

  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 15:721–739

    Article  CAS  PubMed  Google Scholar 

  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 35:375–382

    Article  CAS  PubMed  Google Scholar 

  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 29:1227–1242

    Article  PubMed  Google Scholar 

  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 22:2051–2065

    Article  CAS  PubMed  Google Scholar 

  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 14:1028–1034

    Article  PubMed  Google Scholar 

  21. United Kingdom, National Osteoporosis Society. http://www.nos.org.uk. Accessed 31 Aug 2018

  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):e0198006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Mitchell PJ (2013) Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep 11:52–60

    Article  PubMed  Google Scholar 

  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 24:2135–2152

    Article  PubMed  PubMed Central  Google Scholar 

  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):1623–1629

    Article  CAS  PubMed  Google Scholar 

  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 27:2039–2046

    Article  PubMed  Google Scholar 

  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):513–519

    Article  CAS  PubMed  Google Scholar 

  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 16:977–982

    Article  PubMed  Google Scholar 

  29. Kanis JA, McCloskey EV, Harvey NC, Johansson H, Leslie WD (2015) Intervention thresholds and the diagnosis of osteoporosis. J Bone Miner Res 30:1747–1753

    Article  PubMed  Google Scholar 

  30. Fracture risk assessment tool FRAX. http://www.shef.ac.uk/FRAX. Accessed 31 Aug 2018

  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 34:371–377

    Article  PubMed  Google Scholar 

  32. Pedersen MA, Gregersen M, Langdahl BL, Damsgaard EMS (2014) Frail elderly hip fracture patients and vitamin D. J Gerontol Geriatr Res 3(5):180

    Google Scholar 

  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 21:373–380

    Article  CAS  PubMed  Google Scholar 

  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 12:159–165

    Article  Google Scholar 

  35. Osteoporosis Canada. http://www.osteoporosis.ca. Accessed 31 Aug 2018

  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 78:813–821

    Article  Google Scholar 

  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 77:3–8

    Article  PubMed  Google Scholar 

  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 286:2815–2822

    Article  CAS  PubMed  Google Scholar 

  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 119:810–816

    Article  CAS  Google Scholar 

  40. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767

    Article  PubMed  Google Scholar 

  41. Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018

    Article  CAS  PubMed  Google Scholar 

  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 16:1330–1338

    Article  PubMed  Google Scholar 

  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 22:2395–2411

    Article  CAS  PubMed  Google Scholar 

  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 25:701–709

    Article  CAS  PubMed  Google Scholar 

  45. Langdahl BL (2017) Osteoporosis in premenopausal women. Curr Opin Rheumatol 29:410–415

    Article  PubMed  Google Scholar 

  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 14:571–581

    Article  PubMed  Google Scholar 

  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 82:1493–1501

    Article  PubMed  Google Scholar 

  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 10:26

    Article  PubMed  PubMed Central  Google Scholar 

Download references

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.

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.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Randi M. H. Tei & Bente L. Langdahl

  2. Section for Epidemiology, Department of Public Health, Aarhus University, 8000, Aarhus C, Denmark

    Cecilia H. Ramlau-Hansen

  3. National Center for Register-based Research, Aarhus University, 8000, Aarhus C, Denmark

    Oleguer Plana-Ripoll

  4. Department of Orthopedic Surgery (E), Aarhus University Hospital, 8200, Aarhus N, Denmark

    Ole Brink

Authors
  1. Randi M. H. Tei
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cecilia H. Ramlau-Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oleguer Plana-Ripoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ole Brink
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bente L. Langdahl
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Randi M. H. Tei.

Ethics declarations

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 24 KB)

Supplementary material 2 (DOCX 21 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tei, R.M.H., Ramlau-Hansen, C.H., Plana-Ripoll, O. et al. OFELIA: Prevalence of Osteoporosis in Fragility Fracture Patients. Calcif Tissue Int 104, 102–114 (2019). https://doi.org/10.1007/s00223-018-0476-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00223-018-0476-3

Keywords

Search

Navigation