BoneKEy Reports | BoneKEy Watch

Identifying patients on osteoporosis treatment who are at highest risk of fractures



DOI:10.1038/bonekey.2013.205

Two recent large cohort studies have analyzed the factors associated with fracture risk in patients being treated for osteoporosis.

Prieto-Alhambra et al. screened a database of pharmacy invoices and primary care data from Catalonia in Spain to identify factors that could predict bone fracture in patients being treated with oral bisphosphonates (BPs). Fractures were included and defined as occurring during BP treatment if they occurred at least 6 months after treatment was started and if patients were achieving high compliance. Analysis of the results revealed that 3.4% of highly compliant patients taking oral BPs are likely to sustain a fracture every 12 months. Risk factors identified were previous fracture, low body mass, use of proton pump inhibitors, older age, vitamin D deficiency and diagnosis of an inflammatory arthritis.

Díez-Pérez et al. used data from 26 918 women participants of GLOW – the Global Longitudinal study of Osteoporosis in Women—to identify factors that predisposed patients to having two or more fractures while being treated for osteoporosis. In total 1.3% of the treated group sustained at least two fractures during 3 years of follow-up, compared with 0.6% of controls. Factors predisposing to fracture included unexplained weight loss of 4.5 kg or more, prior fracture, falls in the previous year, comorbidity, ongoing glucocorticoid therapy, lower vitality and physical function at baseline, higher FRAX score and frailty (could not stand without using arms for assistance).

Editor’s comment: Previous fracture was identified as a risk factor in both studies, emphasizing that current therapies cannot reverse severe alterations in the determinants of bone strength. Both studies emphasize the need to identify frailty syndrome more accurately and to develop interventions that prevent fragility fractures more effectively.


Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.