In a cohort of Norwegian men and women with fragility fractures, over half had vertebral fractures, low trabecular bone score, or both, according to study results published in Bone. Anti-osteoporotic drug prescriptions increased 7-fold after assessment, highlighting the importance of post-fragility fracture risk assessments.
Fracture rates in Norway are among the highest in the world. To better understand the use of trabecular bone score in predicting vertebral fractures, researchers in the current study examined the clinical characteristics of a cohort of Norwegian patients with fragility fractures and used vertebral fracture assessment as well as trabecular bone scores to compare groups of patients. Out of 839 patients from the Norwegian Capture the Fracture Initiative (mean age, 65.8 ± 8.8 years; 80.5% women), this cross-sectional substudy was able to explore the differences between 608 patients with bone mineral density (BMD) of the total hip, femoral neck, and/or spine assessed by dual-energy X-ray absorptiometry.
In total, 53.8% of patients had either low trabecular bone score, vertebral fracture, or both. Vertebral fractures were found in 34.8% of vertebral fracture assessments, and 34% of patients had a trabecular bone score ≤1.23, with no differences between sexes. Of 394 patients with osteopenia at the femoral neck, 53.6% had either low trabecular bone score, vertebral fractures, or both. Of all 608 patients, 13.8% had osteoporosis at the femoral neck and 27.4% had osteoporosis at the skeletal site with the lowest BMD T-score.
Women had lower BMD at all sites and lower trabecular bone score compared with men (1.27 vs 1.29; all P <.05). Patients with prevalent vertebral fractures were older in age (69.4 vs 64.0 years) and exhibited lower BMD at all sites, as well as lower trabecular bone score (1.25 vs 1.29) than patients without vertebral fractures (all P <.05). Only 8.2% of patients were taking anti-osteoporotic drugs before assessment compared with 56.2% after assessment.
Limitations to the study included a healthy selection bias, as only patients who were healthy enough to undergo follow-up were invited to participate in the substudy, and potential observation bias.
Study investigators concluded that the large increase in anti-osteoporotic prescriptions after examination “illuminates the treatment gap and importance of assessing patients after a fragility fracture.”
Borgen TT, Bjørnerem Å, Solberg LB, et al. High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: a cross-sectional sub-study of NoFRACT. Bone. 2019;122:14-21.