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


BACKGROUND
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).
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.
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Lih
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Nandapalan
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Kim
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Yap
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Lee
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Ganda
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Seibel
D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004872:Ergocalciferols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010024:Osteoporosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011320:Primary Health Care; D011446:Prospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D004872:Ergocalciferols; D006887:Hydroxycholecalciferols