The incidence of minimal trauma hip fractures is rising with the aging population. While FRAX is a well-validated tool for predicting hip fracture risk, there are additional factors associated with these fractures. This study aims to identify characteristics of patients who sustain hip fractures and to uncover factors not currently captured by existing risk assessment tools.
Methods
A retrospective study of 151 patients with hip fracture, admitted to RNSH between 2nd January 2022 and 18th December 2022. Data were collected from the electronic medical record (eMR). Frailty and FRAX scores were applied retrospectively from available data. A univariate and multivariate regression model was used to identify the factors associated with hip fracture and low FRAX risk.
Results
In our cohort, the median age was 84 years(IQR 76-89), and 70.2% were female. Normal BMI was observed in 50.0%, 70.8% were non-smokers, and 46.6% consumed alcohol. The median NOF Tscore was -2.2SD(-1.75 to -2.8). Median number of falls was 1(0-2) and previous fractures were 0(0-1). Frailty score > 3 was found in 44.5%, and 80.1% lived independently. Only 17.2% were on anti resorptive treatment.
On univariate analysis; age, gender, T score NOF, number of previous fractures, number of medications and frailty status were associated with hip fractures and a FRAX hip fracture risk <3%. Age and gender remained significant on multivariate analysis (p-value <0.05). Additionally, 58.9% of the hip fracture patients did not meet PBS criteria prior to their fracture, although 49.4% had a high FRAX risk.
Conclusion
Our data reveal a high incidence of hip fractures and demonstrate that, despite risk stratifications tools, osteoporosis treatment is infrequently utilised in high risk populations prior to fracture. Our study highlights the need to improve clinical risk tools to capture high risk patients and address the barriers limiting utility of preventative treatment.