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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_7 | Pages 32 - 32
1 Jul 2020
Colgan SM Schemitsch EH Adachi J Burke N Hume M Brown J McErlain D
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Fragility fractures associated with osteoporosis (OP) reduce quality of life, increase risk for subsequent fractures, and are a major economic burden. In 2010, Osteoporosis Canada produced clinical practice guidelines on the management of OP patients at risk for fractures (Papaioannou et al. CMAJ 2010). We describe the real-world incidence of primary and subsequent fragility fractures in elderly Canadians in Ontario, Canada in a timespan (2011–2017) following guideline introduction.

This retrospective observational study used de-identified health services administrative data generated from the publicly funded healthcare system in Ontario, Canada from the Institute for Clinical Evaluative Sciences. The study population included individuals ≥66 years of age who were hospitalized with a primary (i.e. index) fragility fracture (identified using ICD-10 codes from hospital admissions, emergency and ambulatory care) occurring between January 1, 2011 and March 31, 2015. All relevant anatomical sites for fragility fractures were examined, including (but not limited to): hip, vertebral, humerus, wrist, radius and ulna, pelvis, and femur. OP treatment in the year prior to fracture and subsequent fracture information were collected until March 31, 2017. Patients with previous fragility fractures over five years prior to the index fracture, and those fractures associated with trauma codes, were excluded.

115,776 patients with an index fracture were included in the analysis. Mean (standard deviation) age at index fracture was 80.4 (8.3) years. In the year prior to index fracture, 32,772 (28.3%) patients received OP treatment. The incidence of index fractures per 1,000 persons (95% confidence interval) from 2011–2015 ranged from 15.16 (14.98–15.35) to 16.32 (16.14–16.51). Of all examined index fracture types, hip fractures occurred in the greatest proportion (27.3%) of patients (Table). The proportion of patients incurring a second fracture of any type ranged from 13.4% (tibia, fibula, knee, or foot index fracture) to 23% (vertebral index fracture). Hip fractures were the most common subsequent fracture type and the proportion of subsequent hip fractures was highest in patients with an index hip fracture (Table). The median (interquartile range [IQR]) time to second fracture ranged from 436 (69–939) days (radius and ulna index fracture) to 640 (297–1,023) days (tibia, fibula, knee, or foot index fracture). The median (IQR) time from second to third fracture ranged from 237 (75–535) days (pelvis index fracture) to 384 (113–608) days (femur index fracture).

This real-world study found that elderly patients in Ontario, Canada incurring a primary fragility fracture from 2011–2015 were at risk for future fractures occurring over shorter periods of time with each subsequent fracture. These observations are consistent with previous reports of imminent fracture risk and the fragility fracture cascade in OP patients (Balasubramanian et al. ASBMR 2016, Toth et al. WCO-IOF-ESCEO 2018). Overall, these data suggest that in elderly patients with an index fragility fracture at any site (with the exception of the radius or ulna), the most likely subsequent fracture will occur at the hip in less than 2 years.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 131 - 131
1 Mar 2008
Holdsworth D Rajesekaren S Mcerlain D Naudie D Saidi K
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Purpose: Osteoarthritis (OA) is a complex disease process affecting both articular cartilage and underlying bone. An emphasis has been placed on understanding changes in articular cartilage that occur with disease progression, but comparatively little work has been done to understand changes in subchondral bone. The purpose of this study was to evaluate the architectural changes that occur in underlying osteoarthritic bone and to determine their relation to the stages of arthroscopic disease progression.

Methods: Three cadaver knees were evaluated and graded arthroscopically using the Marshall grading system. Representative bone plugs were then extracted from each compartment. Twenty-eight plugs were extracted and imaged using microcomputed tomography (microCT) scanner developed at the Robart’s Research Institute. Volumetric data for each plug biopsy was obtained in 20 minutes of scan time at an isotropic resolution of 68 μm voxels. The data acquired was analyzed using the GE Health Care Scan Control software and reconstruction utility. Subchondral bone thickness bone mineral density (BMD), trabecular thickness (TT), trabecular separation (TS), and structure model index (SMI) were collected and compared in the medial, lateral and patellofemoral compartments of the knees.

Results: No statistical difference was found in any of the parameters when compared with advancing arthroscopic disease progression. When the data was pooled into normal and osteoarthritic specimens, BMD was found to be significantly decreased (p < 0.05) in osteoarthritic bone. A decrease in BVF and an increase in SMI approached significance in osteoarthritic bone.

Conclusions: Further investigation is required for a complete understanding of the architectural changes that occur in subchondral bone with disease progression. A better understanding of OA would have clinical implications in primary and secondary disease prevention. Funding: Other Education Grant