Secondary Fracture Prevention and Forearm Fracture Epidemiology. NoFRACT – The Norwegian Capture the Fracture Initiative

Abstract

<p><i>Background:</i> Osteoporosis and fragility fractures are common, and a burden to patients and society. Forearm fracture are a common fragility fracture. Anti-osteoporotic drugs (AODs) that reduce the risk of future fracture are available, but under 20% of fragility fracture patients receive AODs. To close this treatment gap Fracture Liaison Services (FLS) with systematic identification, assessment, and treatment of osteoporosis is proposed as a solution. The aims was to; i) evaluate the effect of FLS on the risk of future fractures and death, and ii) estimate the incidence of forearm fractures in Norway. <p><i>Methods:</i> Paper I and Paper II describes a stepped-wedge cluster-randomised trial at seven Norwegian hospitals. The FLS intervention went from May, 2015–Dec, 2018 and invited patients over 50 years with low-energy fractures. Patients were systematically assessed and treated for osteoporosis. Analyses were based on data from Norwegian Patient Register (NPR) and included participants in the analyses regardless of exposure to the intervention. There were 57,186 patients in the control group and 47,071 in the intervention group. Paper III: With data from NPR on forearm fractures treated at Norwegian hospitals from Jan, 2008–Dec, 2019 and background population demographics from Statistics Norway we calculated incidence rates and time trends. The study included 181,784 forearm fractures in 45,628,418 person-years (PY). <p><i>Results:</i> Paper II: The FLS reduced the risk of subsequent fragility fractures by 12% and mortality by 26% after the first fracture. Paper III: The mean annual incidence rate of forearm fractures was 565 in women and 231 in men per 100,000 PY and the age-adjusted incidence rates of distal forearm fractures declined somewhat from 2008-2019. <p><i>Conclusion:</i> FLS reduced the risk of subsequent fragility fractures and death. Incidence of forearm fractures in Norway is high. FLSs in all orthopaedic departments as a preventive measures could be a solution.

Beinskjørhet og brudd er svært vanlig og rammer mange i befolkningen. Medisinsk behandling av beinskjørhet kan redusere risiko for brudd med 20-70%, likevel blir de fleste ikke behandlet. En Fracture Liaison Service (FLS), ledet av sykepleier, kan identifisere, teste og behandle osteoporose blant pasienter som har hatt brudd. Vi studerte effekten av FLS på risiko for nye brudd og dødelighet, og beregnet insidens av underarmsbrudd i Norge. FLS ble introdusert ved syv norske sykehus i 2015-16 med oppfølging ut 2019, og utfall fra nasjonale register i en intention-to-treat design. FLS reduserte risiko for nytt beinskjørhetsbrudd med 12%, hoftebrudd med 24% og dødelighet med 26% blant 100,198 kvinner og menn over 50 år som hadde hatt brudd. Insidens av underarmsbrudd blant kvinner og menn over 20 år var 398/100 000 person-år og gjennomsnittlig årlig antall var 15,148 i 2008-19. Samfunnsbyrden av underarmsbrudd er stor i Norge, og FLS kan redusere risiko for både nye brudd og dødelighet.