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Results have been published on an international study which showed that the risk of sustaining a second osteoporotic fracture, after having sustained an initial fracture, was increased. This risk was also drastically increased in women compared to men.

Studies have shown that half of all the patients who have suffered a hip fracture had already sought medical attention because of a previous fracture due to brittle bones. As is commonly experienced, the broken bone is simply fixed and the patient is discharged home without the underlying cause of the first fracture being properly diagnosed and treated.

This issue warranted further research which will be discussed further.

The research

Preliminary results of the Reykjavic Study, which was performed in order to determine what the predictive value of a past major osteoporotic fracture (MOF) was on the development of a future MOF over time, has been presented at a recent orthopaedic world congress.

Data was collected from over 118,000 patients who were born between 1907-1935. Of these patients, it was noted that over 5,000 had experienced one or more osteoporotic fractures and nearly 2,000 had sustained a second fracture.

The findings

The following observations were made on the analyzed data:

  • It was therefore found that the risk of developing a second osteoporotic fracture had increased by 4% for each year of age.
  • It was also discovered that the risk for females was 41% higher than in males.
  • The risk of sustaining the second fracture also seemed to be at its highest immediately after the first fracture.
  • Even though the risk had decreased over time, it still remained higher than the risk to the population throughout follow-up of the patients.
  • The risk of sustaining a second MOF was still 3 times higher than those who had never sustained a fracture.
  • After 10 years, the risk of a second MOF was still 2 times higher than the population who never sustained a fracture.

The clinical significance

This study is very significant in terms of clinical governance. The fact that the risk of a second osteoporotic fracture is immediately increased after an initial fracture is quite concerning.

The findings of the study suggest then that pharmacological management of the affected patient, in order to reduce the risk of a second fracture immediately after the first one, should be considered. This secondary fracture prevention should be promoted in primary care, GP and orthopaedic clinics worldwide.

It is estimated that around 80% of patients who sustained a first fracture were never diagnosed and treated accordingly. In order for this serious issue to be addressed, coordinated systems of secondary fracture prevention need to be implemented. This has become a major health-policy focus of the International Osteoporosis Foundation (IOF).

Complications of osteoporotic fractures

Fractures due to osteoporosis are the most common complications of this disorder. The most commonly involved bones are those of the spine, the wrists and the hips

Secondary complications due to the fractures themselves can also occur, namely:

  • Second fracture - as mentioned above.
  • Deep venous thrombosis - Blood clots can develop in the deep venous system of the leg(s).
  • Pulmonary embolus - The mentioned blood clots can detach and then travel to the pulmonary veins where they cause an obstruction. This can be fatal as cardiac output is then compromised.
  • Stasis pneumonia - due to a fracture possibly immobilizing a patient, airway secretions aren't properly expelled and this can lead to a pneumonia, especially in the elderly.
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