Post-Fracture Risk Assessment: Target The Centrally Sited Fractures First! A Sub-Study of NoFRACT

Abstract

The location of osteoporotic fragility fractures adds crucial information to post-fracture risk estimation. Triaging patients according tofracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracturerisk. The objectives of this cross-sectional study were therefore to explore potential differences between central (vertebral, hip, proximalhumerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoralneck, total hip, and lumbar spine assessed using dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS) calculated, con-comitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire con-cerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1-SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (allp< 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1–SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with centralfragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patientswith peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure,translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fractureprevention, although attention to peripheral fractures should still not be diminished.