FRAX predictions in upper extremity fracture and non-fracture patients
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Osteoporosis is the most common human bone disease and a growing public health problem. Worldwide, 9 million fractures due to osteoporosis occur annually. Fracture is the main burden of the disease and is linked with significant morbidity and mortality. A history of upper extremity fragility fracture is known to contribute to increased risk of subsequent fractures. In this study, we compared the estimated FRAX 10-year probability of major osteoporotic fracture and hip fracture between upper extremity (UE) fracture and non-fracture patients. In addition, we assessed differences in demographics and osteoporosis evaluation between the two groups, and we report the prevalence of lab abnormalities among UE fragility fracture patients evaluated in our fracture liaison service (FLS). A total of 243 patients from Brigham and Women’s Faulkner Hospital were recruited to participate in the study. UE fracture patients were recruited from our FLS, and UE non-fracture patients were recruited from the UE clinic. Overall 10-year probability of major osteoporotic and hip fracture was higher in upper extremity fracture patients than upper extremity non-fracture patients (19.23 versus 9.23, p <0.001 and 4.26 versus 1.54. p < 0.001 respectively). When excluding fragility fracture history, 10-year probability of major osteoporotic fracture and hip fracture were similar between upper extremity fracture and non-fracture patients (10.59 versus 9.23, p = 0.095 and 1.88 versus 1.54, p = 0.215 respectively). The proportion of osteoporosis evaluation via bone mineral density assessment was higher in upper extremity fracture patients compared to upper extremity non-fracture patients (p < 0.001). However, the proportion of upper extremity fracture patients on osteoporosis medication was low and not different than upper extremity non-fracture patients (p < 0.079). Our results highlight history of fragility fracture as an important driver in subsequent fracture risk. UE fracture and non-fracture patients harbor similar fracture clinical risk factors, with the exception of fracture history, and are similarly at risk for future hip fracture and major osteoporotic fracture. Our results suggest close osteoporosis evaluation of older upper extremity non-fracture patients is warranted.