Endocrine Abstracts

Introduction: Fragility fractures are the main consequence of osteoporosis. It results in increased morbidity and mortality. The incidence of fractures has been increasing steadily in Portugal. Hip fragility fractures have been estimated to occur in up to 572/100,000/year in women and up to 232/100,000/year in men.

Methods: A retrospective study of hospitalized patients for femoral neck fracture in our institution in 2018 was performed to evaluate their previous risk of fracture and the predictive factors of one-year mortality. We excluded patients without a fragility fracture or absence of relevant clinical data. The previous absolute risk of fracture was calculated using FRAX-Port. High ten-year fracture risk (without BMD) was considered from 11% for major osteoporotic fracture and from 3% for hip fracture, according to 2018 Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis. Logistic regression was performed to evaluate factors associated with the occurrence of death and included also other risk factors not assessed in FRAX.

Results: We included 193 patients, with a median age of 84.0 years old (IQR 10) and 76.2% were female. Most patients (95.3%) underwent surgery after hospital admission. Globally they were hospitalized for a median of 9 days (IQR 8). They presented a median BMI of 24.44 kg/m² (IQR 6.18), 42% had a previous fragility fracture, 4.1% were smoker at the time, 5.2% had alcohol abuse, 4.7% were under therapy with glucocorticoid, 2.6% had rheumatoid arthritis and 4.7% had a disorder associated to secondary osteoporosis according to FRAX. The majority of patients (77.7%) did not perform previous dual-energy x-ray absorptiometry, even the ones with risk factors for fractures not included in FRAX. Median FRAX was 15.0% (IQR 11) for major osteoporotic fracture and 6.8% (IQR 7) for hip fracture. High absolute risk of fracture without BMD was found in 84.5% of patients. Only 14 patients were under osteoporosis treatment at the time of the fracture and other 14 were under calcium and vitamin D supplementation alone. All-cause mortality was 4.1% in the first 30 days and 19.2% in the first year. The risk of death was 3 times higher in men versus women (OR = 3.223, 95% CI = 1.281-8.107, P < 0.013). It was also positively correlated with age (OR = 1.082, 95% CI = 1.019-1.149, P < 0.011).

Conclusion: Fragility fractures are a dramatic public health problem. This study highlights the importance of the risk fracture evaluation, institution of preventive measures and close follow-up of patients suffering a fracture, given the high rate mortality.