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Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study

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Abstract

Summary

In the present prospective controlled observational study, we investigated the effect of a coordinated intervention program on 4-year refracture rates in patients with recent osteoporotic fractures. Compared to standard care, targeted identification, and management significantly reduced the risk of refracture by more than 80%.

Introduction

The risk of refracture following an incident osteoporotic fracture is high. Despite the availability of treatments that reduce refracture and mortality rates, most patients with minimal trauma fracture (MTF) are not managed appropriately. The present prospective controlled observational study investigated the effect of a coordinated intervention program on 4-year refracture rates and time to refracture in patients with recent osteoporotic fractures.

Methods

Patients presenting with a non-vertebral MTF were actively identified and offered referral to a dedicated intervention program. Patients attending the clinic underwent a standardized set of investigations, were treated as indicated and reviewed at 12-monthly intervals (‘MTF group’). Patients who elected to follow-up with their primary care physician were assigned to the concurrent control group.

Results

Groups were balanced for baseline anthropometric, socio-economic, and clinical risk factors. Over 4 years, 10 out of 246 patients (4.1%) in the MTF group and 31 of 157 patients (19.7%) in the control group suffered a new fracture, with a median time to refracture of 26 and 16 months, respectively (p < 0.01). Compared to the intervention group, the risk of refracture was increased by 5.3-fold in the control group (95% CI: 2.8–12.2, p < 0.01), and remained elevated (HR 5.63, 95%CI 2.73–11.6, p < 0.01) after adjustment for other significant predictors of refracture such as age and body weight.

Conclusions

In patients presenting with a minimal trauma non-vertebral fracture, active identification and management significantly reduces the risk of refracture (Australian New Zealand Clinical Trials Registry ACTRN 12606000108516).

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Acknowledgments

We thank Drs. Kathy Wu, Veena Jayadev and Rohit Rajagapal, Mrs Bev White and Ms Lynley Robinson, and Klaus Sommer, CNC, and his team for their invaluable assistance with this study. We are particularly indebted to Professors David Handelsman and Jackie Center for their insightful comments and statistical advice. We are grateful for the co-operation of our colleagues at the Department of Orthopaedic Surgery, the Orthogeriatric Service, the Emergency Department (all at CRGH), and the patients’ primary care physicians.

The MTF program was supported by logistic support from Concord Repatriation General Hospital, by a Research Entry Grant from Osteoporosis Australia/The Royal Australasian College of Physicians, and by unrestricted research and educational grants from Sanofi-Aventis, Novartis Pharma, and MSD Merck Sharp & Dohme Pharmaceuticals, Australia.

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Concord Repatriation General Hospital, and Bone Research Program, ANZAC Research Institute, The University of Sydney at Concord, Sydney, NSW, 2139, Australia

    A. Lih, H. Nandapalan, M. Kim, C. Yap, P. Lee, K. Ganda & M. J. Seibel

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  1. A. Lih
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  2. H. Nandapalan
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  3. M. Kim
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  7. M. J. Seibel
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Correspondence to M. J. Seibel.

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Lih, A., Nandapalan, H., Kim, M. et al. Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int 22, 849–858 (2011). https://doi.org/10.1007/s00198-010-1477-x

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  • DOI: https://doi.org/10.1007/s00198-010-1477-x

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