Predictive factors for re-fracture in Chinese population with previous osteoporotic fractures

Abstract

Introduction: Osteoporotic fracture is a leading cause for hospital admissions. It is known that the re-fracture rate is 3 to 5 folds higher in subjects with previous low-trauma fractures. The re-fracture rate and its predictive factors in Chinese population with previous osteoporotic fractures are unclear. The purpose of this prospective study was to determine the re-fracture rate and to identify its risk factors for Chinese with fractures. Methodology: A prospective, observational study on Southern Chinese aged 50 and above admitted to Queen Mary Hospital with low-trauma fractures of the hip, spine and distal radius. Subjects were followed yearly by telephone interview for the outcome of refracture. Information was verified from the Hospital Authority Electronic Patient Record System. Fracture of the skull, fingers, and toes were excluded. Cox proportional hazards model was used to identify the clinical risk factors for re-fractures. Results: 2,364 fracture patients (1,606 women and 758 men) admitted to Queen Mary Hospital between 2000 and 2009 were assessed. The mean age at their first fracture was 75.7 ± 10.9 years. At follow-up of 3.8 ± 2.8 years, 268 (11.3%) incident fractures were recorded. The most significant predictors for re-fracture were total hip BMD T-score < -2.5, lumbar spine T-score < -2.5, and quantitative ultrasound T-score < -1. Other predictive factors included smoking, drinking ± 2 glasses per day, oral calcium intake < 800 mg per day, parental hip fracture, outdoor activities with sunshine < 15 minutes per day, body height > 2cm shorter than at age 25, low back pain, difficult in bending forward, walk with aids, history of fall, and serum albumin < 39 g/L. In male subjects, patients with Parkinsonism and serum testosterone < 15 nmol/L were significant associated with re-fracture (Table One). Conclusions: Early identification of subjects with multiple clinical risk factors may help to reduce the re-fracture and hospital re-admission rates. Public health education on adverse lifestyle risk factors is important to reduce osteoporotic fractures.