Subsequent Fracture after Proximal Humerus Fragility Fracture in Patients Included in a Fracture Liaison Service in Spain

Introduction: The objective of this study was to determine the incidence of subsequent fracture following a proximal humerus fracture (PHF) on the basis of an analysis of patients included in a fracture liaison service (FLS) and to identify risk factors for subsequent fracture in these patients.

Methods: This was a retrospective study of patients aged 50 years or older who sustained a low-energy PHF included in an FLS with a minimum follow-up of 2 years. The real incidence of subsequent fractures was calculated as the total number of fractures that occurred during the study period after the index PHF divided by the total number of patients in the study. Descriptive statistics were used to summarise the data. Regression analyses were used to evaluate risk factors for subsequent fracture.

Results: A total of 442 patients were recruited, with a mean age of 75.1 years. (87.33% women and 12.67% men). The incidence of subsequent fracture was 10.18% (n=45) at 2 years. Only 30.32% of patients with PHF had previously received antiosteoporotic drugs. Significant risk factors in the univariable analyses for subsequent fracture were female gender, age >75 years and patients at very high-risk of fracture.

Conclusion: The incidence of subsequent fracture in patients included into an FLS after an index PHF was 10.18% at 2 years. Variables such as female gender, age>75 years and very high-risk patients were significantly associated with subsequent fracture after index PHF. Identifying risk factors for subsequent fracture after a PHF may increase awareness among both patients and healthcare professionals.

Keywords: Proximal Humerus, Fragility Fractures, Subsequent Fracture, Fracture Liaison Service.