The optimal cut-off values of FRAX without BMD for predicting osteoporosis fracture risk in the older adults at Nan, Thailand.

Objectives: The World Health Organization developed the Fracture Risk Assessment Tool (FRAX) to assess the risk of having fragility fractures in the next 10 years. The FRAX tool is different by country, race, gender, and age. This study is a community-based study aiming to identify the optimal cut-off values of FRAX for the identification of older individuals who are at high risk of osteoporosis fractures in both genders. Methods: This cross-sectional, analytic study was conducted by using health screening data of the older adults aged 60-90 living in the 3 biggest districts of Nan province, Thailand. Validity and optimal FRAX major osteoporotic fracture (MOF) and hip fracture (HF) cut-off values in both genders were determined. Results: Of 36,042 older adults included in the study, 1624 older people had a history of fragility fractures. Older females were 3.2 and 2.5 times more likely to have fragility fractures and hip fractures than males, respectively. The optimal cut-off values of FRAX MOF for predicting fragility fractures were 3.0% for males and 6.3% for females. The optimal cut-off values of FRAX HF for predicting hip fractures were 1.1% for males and 3.3% for females. Conclusions: A simple screening tool like the FRAX which is available in the annual health screening activities has the potential to be used to predict the risk of developing fragility fractures in rural areas of Thailand. Different cut-off values should be used in females and males because the risk of MOF and HF of both genders is significantly different.

Risk factors of refracture after a fragility fracture in elderly.

The study examined the risk factors of recurrent fragility fractures in elderly. Female and older age increased the risk of refracture. Older age at the first fracture also resulted in shorter time to the second fracture. The prevention program should be emphasized. PURPOSE: The study examined the characteristics of the fragility fractures and refractures and the factors affecting the incidence and duration to the second fragility fracture. METHODS: The retrospective cohort study reviewed electronic medical records from Nan Provincial Public Health Office, Thailand. Patients aged ≥ 60 years with fragility fractures (hip, wrist, vertebra, and proximal humerus) from low-energy injuries between 1 January 2009 and 31 December 2018 were included. The characteristics of the first and second fractures and the factors that had effect on refracture incidence and duration were investigated. RESULTS: Among 4322 patients, 306 patients (7%) had subsequent fragility fractures. Risk factors of refracture included female (adjusted odd ratio 1.79, 95%CI 1.304-2.467) and older age at the first fracture (adjusted odd ratio 1.016, 95%CI 1.003-1.029). Factor resulted in shorter time to second fracture was older age at the first fracture (ß-coefficient - 0.96, 95%CI - 1.4-(- 0.5)). Any type of the first fracture resulted in similar risk and duration to subsequent fracture. Half (48%) and two-third (65%) of the second fractures occurred within 3 and 4 years, respectively. CONCLUSION: Female and older age were risk factors of subsequent fragility fracture. Older age resulted in shorter time to the second fracture. Refracture prevention program should be initiated in patients with any type of first fragility fracture and should be continued for at least 3-4 years.

One-year mortality rate after fragility hip fractures and associated risk in Nan, Thailand.

OBJECTIVES: Fragility hip fracture is a common secondary complication of osteoporosis, which leads to significant morbidity and mortality. The incidence and prevalence of hip fractures have increased over recent decades. This study established an objective to determine the mortality rate and potential risk factors in fragility hip fracture patients. METHODS: Electronic medical records were retrospectively reviewed. A total of 1412 patients, aged 50 years and over, who sustained and received treatment for hip fractures between 2014 and 2018 were subsequently identified. Mortality rate data were retrieved from the official statistics registry for the provincial population. The mortality rates and potential risk factors for mortality were examined using Kaplan-Meier estimates and multivariate Cox proportional hazard models. RESULTS: The overall 1-year mortality rate of fragility hip fracture patients was 19%. Compared with the age-matched population in Nan province, hip fractures increased the mortality rate by 6.21 times. Additionally, the mortality of hip fracture patients was significantly higher among those with age above 80 years, nonambulatory status before fracture and upon hospital discharge, end-stage renal disease, delirium, and pneumonia. CONCLUSIONS: Patients who sustained hip fractures had approximately 6 times higher mortality. Effective strategies for hip fracture prevention as well as improvement in the standard of care are crucial steps towards reducing mortality in patients with hip fracture.

Epidemiology of fragility hip fractures in Nan, Thailand.

OBJECTIVES: Hip fracture is the most serious consequence of falling in elderly with osteoporosis. Patients with hip fractures suffer functional deterioration and increased morbidity especially during the first year after fracture. Rapid increase in the proportion of the elderly increases the prevalence of hip fractures in Thailand, leading to major problem for public health. There is substantial variation in the incidence of hip fracture in different regions of Thailand. Demographic data are required to improve management and prevention. This study was aimed to describe the demographic data and to determine the incidence of fragility hip fractures in Nan, Thailand. METHODS: A retrospective, cohort study had been conducted in Nan and Pua hospital. Patients with hip fractures were sorted by International Classification of Diseases 10th Revision (S72.0-S72.2) from September 1, 2014 to December 31, 2017. Statistical analyses were conducted using descriptive analysis and 95% confidence interval. RESULTS: The incidence of hip fractures in Nan province in 2015-2017 were 211.6, 214.9 and 238.5 per 100,000 person-years, respectively. There were 876 patients in this study. Higher incidence was found in female (ratio, 2.5:1). About 87.2% of the fracture occurred inside the house. There were 5.9% who had refracture. The median for refracture time was 143 weeks. CONCLUSIONS: The incidence of hip fractures in Nan province was classified as moderate severity and was increasing between 2015 and 2017. A coordinated, multidisciplinary approach in homecare management especially in fall prevention are important factors to reduce incidence of fragility hip fracture.