Background/Purpose: Our Fracture Coordination Unit operates across two hospitals: University Hospital of Donostia (UHD) and Matía Hospital (MH). Patients with a geriatric profile are transferred to MH for Orthogeriatric care, while others receive Rheumatology management at UHD. This study analyzes fragility fracture (FF) risk factors and compares clinical differences between patients with and without previous fractures (pFF) admitted from February 2024 to April 2025.

Methods: A cross-sectional descriptive study was conducted. Clinical, analytical, and treatment variables were collected and processed using the SPSS statistical software. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as medians with confidence intervals. Associations were evaluated using Chi-square and Mann-Whitney U tests, while ANOVA, logistic regression, and multinomial regression were applied to identify factors related to FF.

Results: A total of 176 patients with pFF and 218 without were analyzed. Women were more prevalent in pFF group (88.1% vs. 68.8%, p < 0.0001). Hip fractures were the most common in both groups (p = 0.108). Early menopause was more frequent in pFF (9.7% vs. 3.7%, p < 0.0001), as were familial hip fractures (p = 0.006). Prior osteoporosis treatment was more common in pFF group (28.4% vs. 3.2%, p < 0.0001) (Table 1).Most patients had one pFF (59.1%), while 14.8% had two, 10.2% had three, and 9.09% had between four and six (Table 2).Biochemical analysis showed no significant differences in calcium or phosphorus levels. Total protein levels were lower in pFF (p = 0.028), PTH was significantly reduced (44.5 pg/mL vs. 50 pg/mL, p = 0.029), while vitamin D was lower in both group (14 ng/mL vs. 11.5 ng/mL, p = 0.012).Upon discharge, Ca + VitD supplementation was more frequent in pFF group (86.4% vs. 81.2%, p = 0.040). Differences in prescribed treatments were significant (p < 0.0001), with a higher prescription rate of ZLN and Dmab in pFF group.Age was the key factor in FF, with medians of 85 years for hip fractures, 72.5 for humerus, and 65 for others (p < 0.0001). PTH was highest in multiple fractures (p = 0.013), while TSH showed a marked increase in vertebral FF (p < 0.0001). Dairy intake, alcohol consumption, and smoking had no significant impact (p > 0.05). Regression analysis confirmed that hip fracture risk increases by 15.6% per year (p = 0.015, OR = 1.156) (table 3).

Conclusion: The results reveal significant differences between the groups. Women, with early menopause or a family history of hip FF, face a higher risk. Both groups had insufficient VitD, emphasizing the need for better detection and treatment. Prior osteoporosis treatment was more frequent in pFF group, where fracture recurrence underscores the importance of adherence and treatment optimization.In the pFF group, the first FF occurred at a median age of 75 years. As fracture count increased, tracking patient history became more challenging. The multinomial logistic regression model confirms age as the primary determinant of fracture risk. These findings highlight the need for prevention and clinical monitoring, as patients with a pFF are at greater risk of future fractures.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/multidisciplinary-fragility-fracture-management-across-two-coordinated-hospitals-evaluating-risk-factors-treatment-approaches-and-long-term-patient-outcomes-in-those-with-and-without-prior-fracture/