Refracture following vertebral fragility fracture when bone fragility is not recognized: summarizing findings from comparator arms of randomized clinical trials.

Refracture Subsequent fractures Systematic review Vertebral fragility fracture

Journal

Journal of endocrinological investigation
ISSN: 1720-8386
Titre abrégé: J Endocrinol Invest
Pays: Italy
ID NLM: 7806594

Informations de publication

Date de publication:
03 Nov 2023
Historique:
received: 19 06 2023
accepted: 10 10 2023
medline: 3 11 2023
pubmed: 3 11 2023
entrez: 3 11 2023
Statut: aheadofprint

Résumé

Since vertebral fragility fractures (VFFs) might increase the risk of subsequent fractures, we evaluated the incidence rate and the refracture risk of subsequent vertebral and non-vertebral fragility fractures (nVFFs) in untreated patients with a previous VFF. We systematically searched PubMed, Embase, and Cochrane Library up to February 2022 for randomized clinical trials (RCTs) that analyzed the occurrence of subsequent fractures in untreated patients with prior VFFs. Two authors independently extracted data and appraised the risk of bias in the selected studies. Primary outcomes were subsequent VFFs, while secondary outcomes were further nVFFs. The outcome of refracture within ≥ 2 years after the index fracture was measured as (i) rate, expressed per 100 person-years (PYs), and (ii) risk, expressed in percentage. Forty RCTs met our inclusion criteria, ranging from medium to high quality. Among untreated patients with prior VFFs, the rate of subsequent VFFs and nVFFs was 12 [95% confidence interval (CI) 9-16] and 6 (95% CI 5-8%) per 100 PYs, respectively. The higher the number of previous VFFs, the higher the incidence. Moreover, the risk of VFFs and nVFFs increased within 2 (16.6% and 8%) and 4 years (35.1% and 17.4%) based on the index VFF. The highest risk of subsequent VFFs or nVFFs was already detected within 2 years following the initial VFF. Thus, prompt interventions should be designed to improve the detection and treatment of VFFs, aiming to reduce the risk of future FFs and properly implement secondary preventive measures.

Identifiants

pubmed: 37921990
doi: 10.1007/s40618-023-02222-0
pii: 10.1007/s40618-023-02222-0
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. The Author(s).

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Auteurs

G Porcu (G)

Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy. gloria.porcu@unimib.it.
Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy. gloria.porcu@unimib.it.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. gloria.porcu@unimib.it.

A Biffi (A)

Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.

R Ronco (R)

Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.

G Adami (G)

Rheumatology Unit, University of Verona, Verona, Italy.

R Alvaro (R)

Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.

R Bogini (R)

Local Health Unit (USL) Umbria, Perugia, Italy.

A P Caputi (AP)

Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy.

B Frediani (B)

Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.

D Gatti (D)

Rheumatology Unit, University of Verona, Verona, Italy.

S Gonnelli (S)

Department of Medicine, Surgery, and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy.

G Iolascon (G)

Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.

A Lenzi (A)

Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy.

S Leone (S)

AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy.

R Michieli (R)

Italian Society of General Medicine and Primary Care (SIMG), Florence, Italy.

S Migliaccio (S)

Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy.

T Nicoletti (T)

CnAMC, Coordinamento nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy.

M Paoletta (M)

Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy.

A Pennini (A)

Rheumatology Unit, University of Verona, Verona, Italy.

E Piccirilli (E)

Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.
Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy.

M Rossini (M)

Rheumatology Unit, University of Verona, Verona, Italy.

U Tarantino (U)

Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy.
Department of Orthopedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy.

L Cianferotti (L)

Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy.

M L Brandi (ML)

Italian Foundation for Research on Bone Diseases (FIRMO), Florence, Italy.

G Corrao (G)

Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.

Classifications MeSH