Objective: To investigate whether patients with secondary osteoporosis or other metabolic bone disease (SECOB) have a higher re-fracture or mortality risk.
Method: Patients with a recent non-vertebral fracture who visited the Fracture Liaison Service (FLS) of a hospital were prospectively followed for 2 years. Pearson Chi-square, Fishers Exact test, independent samples T-test, and Cox regression models were used.
Results: In total, 713 patients were invited to attend the FLS, and 510 attended (78.4% women). Of the 510 patients, 179 (35.1%) had osteoporosis, 251 (49.2%) were osteopenic, and 80 (15.7%) had normal bone mineral density (BMD). In total, 215 patients (42.2%) had known or newly diagnosed SECOB (77.7% women). Patients with SECOB were significantly older (68.9 vs 64.4 years, P<0.001) had lower BMD (T-score: −2.3 vs −1.9, P<0.001), were prescribed more bisphosphonates or PTH (53.6 vs 46.4%, P<0.001) and sustained more initial hip fractures (57.4% vs 42.6%, P=0.042) than patients without SECOB. Gender (women: 41.8 vs 43.6%, P=0.723) was not significantly different.
In total, 37 patients (7.3%) re-fractured and 15 (3.0%) died within 2 years of follow-up. The absolute re-fracture risk was not significantly different between patients with or without SECOB (8.8 vs 6.1%, P=0.240; relative risk (RR): 1.2). However, absolute mortality risk was significantly different (6.1 vs 0.70%, P=0.001; RR: 8.9). Although the numbers of events are small (<10%), Cox models showed similar results: no significant differences for re-fracture risk, but age-adjusted mortality risk was significantly higher for patients with SECOB (hazard ratio: 7.0, 1.631.8).
Conclusion: Two out of five patients, who attend the FLS because of a recent fracture, had SECOB. Absolute re-fracture risk is similar between patients with or without SECOB, but mortality risk is substantially higher in patients with SECOB.
17 May 2014 - 20 May 2014