Fragility Fractures in Patients Admitted to Assaf Harofeh Medical Center: Clinical Characteristics and Pre-fracture Risk Assessment

Objective: Timely diagnosis and optimal treatment of osteoporosis prevents fractures. However, the majority of patients presented with a fragility fracture are neither assessed for osteoporosis nor appropriately managed. The goal of the study was to investigate the pre-admission screening process and pre-fracture risk assessed by FRAX with no BMD data, with the aim of improving primary prevention.

Methods: A retrospective analysis of prospective data collection of new fragility fracture cases admitted to the orthopedic ward at Assaf Harofeh Medical Center from March to December 2016.

Results: We enrolled 157 patients, 121 (77.1%) females, with mean age 78 and 36 (22.9%) males with mean age of 80.9.

Most common Fracture location was hip (79.6%), spine (11.4%), after which humerus and distal radius (8.9%).

From our cohort group, only 61 patients (39.6%) had a previous diagnosis of OP, 58 patients (36.9%) had another osteoporotic fracture before admission to our department, out of which 22 were not diagnosed as OP nor treated.
Only 26 of the diagnosed OP patients were persistent with medications at admission. Comparison of naïve vs known OP groups revealed that males are less likely to have OP diagnosed and treated, while fracture site did not differ between groups.

Excluding OP active treated patients (n=123), the pre-fracture risk in males and females was 7% and 11% respectively for the hip (p=0.0192), with 86.2 and 80.5% of the male/female above the 3% cut off. The major osteoporotic pre-fracture risk in males and females was 11.6 and 20.4% respectively (p<0.01), with 10.3% and 55.3% above the 20% cut off.

Conclusion: Patients presenting with fragility fracture have a pre-fracture risk high enough to be used to tag them for thorough OP evaluation and possible treatment. Our small cohort supports a wider use of no-BMD FRAX score system as a tool for primary prevention.