Characteristics Of Hip Fracture Patients With And Without Previous Minimal Trauma Fractures: Are We Missing Secondary Prevention?

Abstract

Introduction: Minimal trauma fracture (MTF) is a recognized risk factor for subsequent fractures including hip fractures (HF).1 Antiosteoporotic treatment is recommended for secondary bone fracture prevention, but data on its use and efficacy are limited and controversial.2, 3 Aims: To evaluate the incidence of MTF prior to the hip fracture (HF), and compare main parameters of mineral and bone metabolism in patients with and without prior MTF in regard to antiosteoporotic treatment after the first event. Methods: In 327 consecutive elderly (>60 years) patients admitted to the Canberra Hospital (1 January - 31 December 2012) with a HF (mean age 82.7 + 9.9 [SD] years; 73% females) data on hospital presentations within the last 5 years with MTF, osteoporotic treatment and biochemical profiles including serum levels of procollagen type 1 N-terminal propeptide (PlNP,bone formation marker), collagen type 1 cross-linked Ctelopeptide (CTX, bone resorption marker), 25 (OH) vitamin D and PTH were recorded and analysed. Results: Among 327 HF patients, 112 (34.2%, group 1) had a previous MTF [137 fractures including 76(55.4%) vertebral, 28(20.4%) hip, 21(15.3%) upper limb, 7 (5.6%) pelvic, and 5 (3.5%) lower limb] and the rest 215 (65.8%, group 2) did not. Only 36 (32%) patients in group1 at the time of previous MTF were discharged on antiosteoporotic treatment. The group1 comparing to group2 was significantly older (85.0 + 8.1 vs. 81.4 + 10.7 years, p = 0.002), had higher mean 25 (OH) vitamin D levels (69.9 + 27.5 vs. 55.5 + 25.4 nmol/L, p < 0.001 ), a trend to lower prevalence of hypovitaminosis D (<50 nmol/L in 31.2% vs. 43.5%, p = 0.070) as well as secondary hyperthyroidism (SHPT: PTH > 7.2 pmol/L, 40.8% vs. 51.4%, p = 0.100).The patients discharged on antiosteoporotic therapy demonstrated lower CTX values (0.47 + 0.3 vs. 0.63 + 0.3 μg/L, p = 0.04), a tendency to lower prevalence of hypovitaminosis D (20.0% vs. 26.5%, p = 0.800), but not SHPT (41.9% vs. 41.6%). Conclusion: One third of HF patients had a previous MTF, but the majority of them did not received antiosteoporotic treatment after the event. However, the low effectiveness of secondary bone fracture prevention with currently recommended therapy necessitates an urgent need of new approaches.