Oral Presentation ESA-SRB-NZSE-CaSR 2026 in conjunction with ENSA

Predictors of re-fracture and mortality within a secondary fracture prevention program: insights from up to 15-years follow-up     (143110)

Mawson Wang 1 2 , Dominic Cavenagh 3 , Divia Mohandas 4 , Markus J Seibel 1 2 , Kirtan Ganda 1
  1. Department of Endocrinology & Metabolism, Concord Hospital, Concord
  2. Bone Research Program, ANZAC Research Institute, Concord, NSW, Australia
  3. Centre for Women's Health Research, University of Newcastle, Newcastle, New South Wales, Australia
  4. Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia

Background
Fracture liaison services (FLS) have been established globally to assist with secondary fracture prevention and reduce the risk of re-fractures. Predictors of re-fracture and mortality amongst patients managed within a FLS are not well established.

Methods
This long-term prospective observational study included 526 patients with prevalent osteoporotic fractures, originally recruited between 2005-2010, and managed by the Concord Hospital FLS according to best practice. Clinical and anthropometric characteristics were recorded at follow-up visits. Long-term data on re-fracture status, mortality and pharmacotherapy adherence were obtained via government data linkage. The primary outcome was to determine the predictors of re-fracture and mortality. Secondary outcomes were mortality rate and adherence to osteoporosis pharmacotherapy.

Results
Mean age was 66 years (SD 11) and 80% were female. During a median follow-up of 11.7 years (range 0.5-15.4), the incidence rates per 1,000 person-years were 50.1 (CI:44.0-57.0) for any osteoporotic re-fracture, 24.9 (CI:21.0-29.6) for major osteoporotic re-fracture and 10.2 (CI: 7.9-13.2) for hip re-fracture. Multivariable predictors of major osteoporotic re-fracture included any falls <12 months (SHR 2.06,CI:1.33-3.20), lower femoral neck (FN) BMD (SHR 1.55,CI:1.20-2.00) and 2-year medication possession ratio <0.5 (SHR 1.73,CI:1.12-2.66). Consuming ≥3 standard drinks/day of alcohol predicted any osteoporotic re-fracture (SHR 2.25,CI:1.07-4.72), while increasing age predicted hip re-fracture (SHR 1.67,CI:1.14-2.45). Overall mortality was 28.7%, with re-fracture associated with increased mortality. In both sexes aged >80 years, the mortality rate was >3 times higher in those who re-fractured compared to those who did not. Increasing age (HR 2.96,CI:2.24-3.92), male sex (HR 2.42,CI:1.34-4.39) and lower FN BMD (HR 1.37,CI:1.08-1.74) were also independent predictors of mortality.

Conclusion
Amongst one of the longest-running FLS cohorts, prevalent falls, lower FN BMD and poor pharmacotherapy adherence predicted re-fracture; while re-fracture, male sex and lower FN BMD predicted mortality. Early identification of these high-risk individuals is crucial to improve long-term outcomes.