Danish, national cross-sectional observational study on the prevalence of prior major osteoporotic fractures in adults presenting with hip fracture-limitations and scope for fracture liaison services in prevention of hip fracture

Abstract

Fracture liaison services prevent hip fractures by identifying other osteoporotic fractures that generally debut at a younger age. However, this study showed that a minority of hip fracture patients are already known to the health services through having had prior osteoporotic fractures. Identification of vertebral fractures in particular is lacking.

Introduction: The purpose of this study was to examine the prevalence of prior major osteoporotic fractures (MOF) in the prior 10 years preceding hip fracture in order to provide information about the potential for prevention of hip fractures by fracture liaison services (FLS).

Methods: We included all patients aged 50+ with surgically treated hip fracture in one calendar year (N = 8158) in the Danish Hospital Discharge Register. Prior fractures were identified using the same data source. A prior hip fracture was only included as a prior fracture if occurring more than 6 months before the present fracture.

Results: A total of 28% of hip fracture patients (32% of women and 19% of men) had at least one recognized MOF in the preceding 10 years. Forearm and humerus fractures constituted > 70% of prior MOF. In both genders, vertebral fractures only represented a small percentage (2.6%) of previously recognized MOF. Men were less likely than women to have experienced a prior MOF, chiefly due to fewer forearm and humerus fractures.

Conclusion: The majority of hip fractures-and in particular hip fractures in men-occur without a previously treated MOF that could have resulted in early detection and treatment of osteoporosis. With current treatment modalities, a maximum of one in six hip fractures in Denmark can be prevented through FLS initiatives. Identification of patients with vertebral fractures for assessment and treatment is therefore critical for successful prevention of hip fractures using this strategy.

Keywords: Epidemiology; Fracture liaison services; Hip fracture; Osteoporosis.