Do you know what the imminent risk of fracture is?

This is the 5143th article of Da Yi Xiao Hu

An elderly female patient in the inpatient department was diagnosed with osteoporotic compression fracture of T12 vertebra. She recovered well after vertebroplasty. When she was about to be discharged, the doctor explained her condition to the patient and her family: "Osteoporosis is a systemic disease. Although the pain has basically disappeared after the surgery, the osteoporosis has not improved. She needs regular anti-osteoporosis treatment, and pay special attention to the risk of 'imminent death'." The patient and her family were confused: "What is the risk of imminent death?" Obviously, everyone was unfamiliar with the meaning of this term.

What is an imminent risk?

Imminent risk mainly refers to the high risk of re-fracture within 2 years after osteoporotic fracture, which may occur at any time, so prevention is imminent, and the risk of re-fracture within 2 years is an "imminent" risk. It mainly comes from Johansson et al. in 2017, after 27 years of follow-up, found that the risk of re-fracture within 1 year after the first fracture was 2.7 times that of the normal population, and 1.4 times after 10 years; the risk of re-fracture increased by 5% with each year of age increase; the overall data analysis found that: the incidence of re-fracture within 2 years after the first osteoporotic fracture is the highest, and then it tends to decrease with time. Therefore, the study emphasizes that the risk of re-fracture within 2 years after MOF is very high, which is an "imminent" risk. Within 2 years after fracture, it is necessary to strengthen clinical management after fracture, and it is also an important time period (window period) for the prevention and treatment of re-fracture. If done well, it can achieve twice the result with half the effort, so orthopedic doctors attach great importance to it!

What is the current situation and what are the hazards?

Neither patients nor their families generally pay enough attention to the risk of re-fracture.

The risk of another fracture increases by 80% after the first osteoporotic fracture, which often occurs within 3 months after the first fracture, and this high risk will continue for 1 year. If the treatment or intervention is not standardized within two years, or even the intervention is not completed, the risk of another fracture will increase exponentially. After another fracture occurs, the risk of a third fracture increases by nearly 200%. The risk of a single fracture may not have much impact on the patient's life, but if a second or third fracture occurs, especially a high-risk fracture such as an osteoporotic hip fracture, the patient's mortality rate will increase significantly.

How to reduce the risk of refracture?

Preventing further fractures requires collaboration between doctors, patients, their families, and even the community and community service centers.

Patients need to improve their awareness of the risk of re-fracture after osteoporotic fractures, pay attention to it, improve treatment compliance, and receive regular anti-osteoporosis treatment. At the same time, they need to strengthen nutrition, exercise properly, and especially take various measures to prevent falls. They should keep in touch with their family doctors and attending physicians and provide timely feedback to minimize the occurrence of re-fractures.

Author: Department of Orthopedics, Tianjin Third Central Hospital

Guo ShuzhangChief Physician