Bone Abstracts

Fracture outpatient (FO) clinics aim to identify individuals at high fracture risk. Identification of individuals at high fracture risk has been improved since the introduction of vertebral fracture assessment (VFA). Unfortunately, participation rates in FO clinics are often low.

The aim of this study is to i) assess the contributory value of VFA in addition to BMD measurements in identifying individuals with high fracture risk; ii) assess characteristics of individuals with as compared to those without vertebral fractures; and iii) determine characteristics related to non-participation to the FO clinic.

Data from the FO clinic of the VU University Medical Center were used. Individuals aged 50 years and over who presented with a fracture at the emergency ward between 2006 and 2012 were invited and underwent fracture risk assessment including BMD measurements and VFA with dual-energy X-ray absorptiometry. High fracture risk is defined as T-score ≤−2.5 and/or one or more vertebral fractures (loss of vertebral height ≥25%).

Participation rate of the FO clinic was 1664 (39%) of 4204 invited individuals. Individuals who did not participate were older, were more often male, more often had two or more fractures at a time and more often had a hip fracture. They less often had a wrist fracture.

Of screened individuals 709 (42.6%) participants had a high fracture risk, 327 (46.1%) on the base of vertebral fractures without the presence of low BMD (T-score >−2.5). Of 466 patients with a vertebral fracture, 233 (50.0%) had osteopenia and 93 (20.0%) had a normal BMD. Patients with a vertebral fracture were older, had lower BMD, had more often been immobilized, more often reported loss of height and body weight <60 kg than patients without a vertebral fracture.

To conclude, almost half of individuals with high fracture risk in the FO clinic was identified on the base of vertebral fractures in the absence of low BMD. Individuals with vertebral fractures are characterized by higher age, more frequent immobilisation, loss of height and/or body weight <60 kg. Finally, recruitment of FO clinics should be more actively aimed at older males, individuals with more than two fractures and/or hip fractures.