Risk of Subsequent Fragility Fractures Observed After Low-Trauma Ankle Fractures

Area of Science:

• Orthopedics
• Gerontology
• Public Health

Background:

• Fragility fractures (FFs) are strong predictors of subsequent osteoporotic fractures.
• The predictive ability of low-trauma ankle fractures for subsequent FFs is not well-established.
• The OPTIMUS initiative aims to improve osteoporosis treatment post-FF in orthopedic clinics.

Purpose of the Study:

• To identify characteristics of patients with low-trauma ankle FFs who develop subsequent FFs.
• To evaluate the incidence and predictors of recurrent FFs after an initial ankle fracture.
• To assess the role of ankle fractures in predicting future osteoporotic fractures.

Main Methods:

• A cohort of 265 patients with initial ankle FFs was followed for 48 months.
• Recurrent FFs were X-ray confirmed.
• FRAX scores without bone mineral density (FRAX-BMI) were calculated at inclusion.

Main Results:

• Patients with initial ankle FFs had a lower incidence of recurrent FFs compared to those with wrist or other initial FFs (4-year incidence: 6.2% vs. 13.4-15.3%).
• Recurrent FFs were more frequent in patients with a previous FF or high-risk FRAX-BMI scores.
• Ankle FFs themselves did not predict subsequent FFs overall.

Conclusions:

• Low-trauma ankle fractures are not strong predictors of subsequent fragility fractures.
• Patients with ankle FFs who have a history of previous FFs or high FRAX-BMI scores are at higher risk for recurrent fractures.
• Ankle FFs may serve as a clinical opportunity to identify and treat at-risk patients, but their inclusion in FRAX-BMI calculations may not be warranted.