POS0162 PREDICTIVE FACTORS OF A NEW FRAGILITY FRACTURE AFTER WRIST FRAGILITY FRACTURE
Authors: S. Azevedo, H. Parente, D. Esperança Almeida, F. Guimarães, J. Rodrigues, D. Faria, D. Peixoto, J. Tavares-Costa, C. Afonso, F. Teixeira
Journal: Annals of the Rheumatic Diseases (2021)

Background: Fragility fractures (FF) are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or ‘low energy’) trauma. 1 Studies have shown that history of wrist fracture increases the risk for subsequent FF. 2 Objectives: To assess predictive factors of FF occurring after a wrist fracture. Methods: Retrospective monocentric study that included patients with a wrist FF observed at the emergency department (ED) in a tertiary center, between 1 st January 2017 and 31 st December 2018. Wrist fractures were identified through the 10th International Classification of Diseases and FF were identified after revision of the clinical record. Patients with relevant missing data were excluded. Seven hundred thirty-three wrist FF were identified. After calculating a representative sample (90% confidence interval), 188 patients were included. Their clinical records until 31th December 2020 (2 to 3 years after FF) were reviewed. SPSS was used for statistical analysis and significance level was defined as 2-sided p&lt;0.05. In multivariate analysis we included variables with a significant association in univariate analysis and those with clinical relevance (reported in others studies). Results: Wrist fractures represented 44.3% of the FF observed at the ED. Most patients were woman (83.5%) with a mean age of 70.7 (SD=11.2) years-old at the time of their wrist fracture. A previous FF was seen in 22.9% of patients and 13.3% had a new FF during the follow-up period. We found an association between the occurrence of a new FF and the number of comorbidities (p=0.012), number of visits to the ED due to falls (p&lt;0.001), previous diagnosis of chronic pulmonary disease (p=0.029) and hematologic pathologies (p=0.047), and the need for hospitalization at time of the wrist FF (p=0.018). No associations were found between the age at the wrist fracture time, number of drugs taken daily nor its type (anxiolytics, antiepileptics, corticoids), previous fractures (and localization), overweight/obesity and other cardiovascular risk factors, endocrinopathies, psychiatric or neurologic disease or other comorbidities. After adjustment for age, gender, anti-osteoporotic treatment and comorbidities, the main predictors of a new FF were visits to the ED for falls (p=0.005), chronic pulmonary disease (p=0.040), hematologic pathologies (p=0.004) and need for hospitalization (p=0.040) (table 1). Table 1. Multivariate analyses: linear multiple regression for predictive factors of new fragility fracture. Determinants Unstandardized Coefficients B Standardized Coefficients Beta 95.0% CI p-value Age -0.025 0.975 0.924 – 1.030 NS Gender 2.065 7.889 0.757 – 82.165 NS Number of comorbidities 0.186 1.204 0.846 – 1.713 NS Visits to the emergency service for falls -2.136 0.118 0.026 – 0.529 0.005 Chronic pulmonary disease -1.326 0.266 0.075 – 0.940 0.040 Hematologic pathologies -4.296 0.014 0.001 – 0.255 0.004 Need for hospitalization -2.764 0.063 0.004 – 0.887 0.040 Anti-osteoporotic treatment 0.157 1.170 0.227 – 6.017 NS CI: Confidence Interval; NS: non-significant; Conclusion: Certain comorbidities seem to be associated with new FF. Patients with visits to the emergency service after falls and those who needed hospitalization due to the wrist fracture were more prone to have a new FF. There might be a substantial missed opportunity for intervention in these patients. References: [1]Osteoporosis: assessing the risk of fragility fracture. London: National Institute for Health and Care Excellence (UK); 2017 Feb. PMID: 32186835. [2]Crandall CJ, Hovey KM, Cauley JA, Andrews CA, Curtis JR, Wactawski-Wende J, Wright NC, Li W, LeBoff MS. Wrist Fracture and Risk of Subsequent Fracture: Findings from the Women’s Health Initiative Study. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research. 2015;30(11):2086–2095. doi: 10.1002/jbmr.2559. Disclosure of Interests: None declared