OFELIA: Prevalence of Osteoporosis in Fragility Fracture Patients
- 173 Downloads
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.
KeywordsOsteoporosis Secondary fracture prevention Fracture risk assessment Screening
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.
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.
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.
The study complies with the principles outlined in the Declaration of Helsinki. The study was approved by the Danish Data Protection Agency.
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.
- 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
- 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.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.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.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.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.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
- 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):e0198006CrossRefGoogle Scholar
- 30.Fracture risk assessment tool FRAX. http://www.shef.ac.uk/FRAX. Accessed 31 Aug 2018
- 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
- 35.Osteoporosis Canada. http://www.osteoporosis.ca. Accessed 31 Aug 2018
- 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
- 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.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