A combined fracture and mortality risk index useful for treatment stratification in hip fragility fractures
Erdem Aras Sezgin1, Ahmet Toygun Tor2, Vėtra Markevičiūtė3, Aurimas Širka3, Šarūnas Tarasevičius3, Deepak Bushan Raina4, Yang Liu4, Hanna Isaksson5, Magnus Tägil4, Lars Lidgren4
1Department of Orthopedics and Traumatology, Aksaray University Faculty of Medicine, Aksaray, Turkey
2Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey
3Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
4Department of Orthopaedics, Lund University, Clinical Sciences Lund, Lund, Sweden
5Department of Biomedical Engineering, Lund University, Lund, Sweden
Keywords: Augmentation, hip fracture, osteoporosis, risk factors, stratification.
Abstract
Objectives: In this study, we aimed to assess the stratification ability of the Fracture and Mortality Risk Evaluation (FAME) index for reoperation, new fragility fracture, and mortality during one-year follow-up.
Patients and methods: Between November 2018 and July 2019, a total of 94 consecutive hip fragility fracture patients from two centers (20 males, 74 females; mean age: 79.3±8.9 years; range, 57 to 100 years) were retrospectively analyzed. The patients were classified into high, intermediate, and low fracture and mortality risk groups according to the Fracture Risk Assessment Tool (FRAX) score and Sernbo score, respectively, as well as nine combined categories according to the FAME index. Hospital records were reviewed to identify re-fractures (reoperations, implant failure, new fragility fractures on any site) and mortality at one year following the FAME index classification.
Results: Overall re-fracture and mortality rates were 20.2% and 33%, respectively. High fracture risk category (FRAX-H) was significantly associated with higher re-fracture (odds ratio [OR]: 2.9, 95% confidence interval [CI]: 1-8.2, p=0.037) and mortality rates compared to others (OR: 3.7, 95% CI: 1.5-9.3, p=0.003). The patients classified within the FRAX-H category (n=35) had different mortality rates according to their Sernbo classification; i.e., patients classified as low mortality risk (Sernbo-L) (n=17) had lower mortality rates compared to others in this group (n=18) (35.3% and 66.7%, respectively), indicating a low statistical significance (OR: 0.3, 95% CI: 0.1-1.1, p=0.063). Similarly, within patients classified in Sernbo-L category (n=64), those classified as high fracture risk (FRAX-H) (n=17) had significantly higher re-fracture rates compared to others in this group (n=47) (35.3% and 8.5%, respectively), (OR: 5.9; 95% CI: 1.4-24.5), (p=0.017). Multivariate logistic regression analyses adjusting for covariates (age, sex, length of hospital stay and BMI) yielded similar results.
Conclusion: The FAME index appears to be a useful stratification tool for allocating patients in a randomized-controlled trial for augmentation of hip fragility fractures.
LL is a board member of Bone Support AB, Lund, Sweden and Ortho Cell, Australia. The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The financial support to the researchers was granted by VINNOVA innovation agency in Sweden (grant 2017–00269), VR-The Swedish Research Council (grant 2015–06717) and the Foundation for Disabled people in Scania, Sweden. The funding bodies had no role in the design of the study, data collection, analysis, and interpretation of data or in writing the manuscript.