gms | German Medical Science

Objectives: Clinical Guidelines suggest that every patient, after suffering an index fragility fracture, should immediately be provided with an osteoporosis treatment. But elderly fragility fracture patients are known for an over proportional mortality rate. This is when the latency until effect of therapy for osteoporosis comes into play.Elderly fracture patients may not experience reduction of fracture risk as result of a newly started osteoporosis therapy: patients could die before the medication can make an impact. Is this scenario only in theory or does it have clinical importance? To answer this question in a real world setting, we took advantage of a quality assurance measure about our Fracture Liaison Service.

Methods: From January 2021 to January 2022, data were collected from all patients aged 65+ (n=1,381, female:male=73%:27%, mean age=83 years) who were treated as “in-patients” because of a fragility fracture. Patients with fractures due to high energy trauma, isolated skull, toes, or finger fractures, as well as fractures resulting from metastatic bone disease (n=368) were excluded. The one-year follow-up determined the occurrence of subsequent fragility fractures as well as mortality.

Results and conclusion: Initial fragility fractures included; Hip Fractures (30%), Pelvic Fractures (15%), Humerus Fractures (15%), Distal Radius Fractures (12%), Vertebral Fractures (15%) and other Fractures (13%). Follow-up was achieved in 82.4% of patients: Death occurred in 32% of the patients and 12.5% suffered from another fragility fracture. 0.9% of the cohort suffered from both events.

Based on these results, the indication for therapy of osteoporosis in elderly fragility fracture patients is challenged. Shared decision making and individualized therapy may allow physicians an opportunity to choose a treatment path more wisely and enlarge the scope of geriatric fracture care management beyond fracture reduction alone.