Comorbidity in patients with fragility fractures: analysis of “GISMOA study”

Introduction. Fragility fractures are a major cause of disability and death [1,2] among people in western countries. Italy is one of the countries with the highest life expectancy in the world. The increase in life expectancy is associated with a greater frailty of elderly people and a higher prevalence of chronic and degenerative diseases, including osteoporosis [3]. The aim of our study is to evaluate comorbidities in a population with fragility fractures. Materials and methods. We conducted a Regional Survey on behalf of GISMOA (Gruppo Interdisciplinare per lo Studio delle Malattie Osteo-Articolari) involving 11 physicians experienced in osteoporosis working in Campania Region. We asked each physician to collect data on osteoporotic patients over 50 years of age. For each patient they had to fill a form including: questions about medical history, evaluation of comorbidities through Comorbidity Illness Rating Scale, type and number of fragility fractures. Results. Of the 845 forms we excluded 159 patients because they did not meet the inclusion criteria or the data were incomplete, therefore the analysis was carried out on 687 patients with a mean age of 66.3 years. 665 (96.93%) were females. Of these patients 364 (53.06%) had a history of fragility fracture and 62 had more than one fracture. In particular 189 (51.92%) patients reported a history of vertebral fracture, 32 (8.79%) of hip fracture, 10 (2.74%) pelvis fractures; 31 (8.51%) humeral fractures, 99 (27.19%) wrist fractures, 11 (3.02%) both vertebral hip fracture. The mean Comorbidity Index (C.I) and Severity Index (S.I.) in patients with a vertebral fracture were respectively 1.04 and 1.19. The mean C.I. and S.I. in patients with multiple vertebral fractures was respectively 1.78 and 1.19. The mean C.I. and S.I. in patients with a fracture of the hip was respectively 1.73 and 1.38; the mean C.I. and S.I. in patients with a hip fracture and vertebral fractures were respectively 2.54 and 1.61. Conclusions. Our results confirmed that comorbidity is a major issue in patients with a history of multiple vertebral fractures and in the patients with fracture of the hip and vertebral fractures. Furthermore the C.I. of patients with multiple fracture was overlapped to the C.I. of the patients with a hip fracture. Therefore an appropriate management of comorbidities should be always taken into account in the comprehensive treatment of patients with fragility fractures. Bibliografia 1. The New England Journal of Medicine, Screening for Osteoporosis. Lawrence G. Raisz, M.D.. N.Engl J Med 2005; 353: 164-71. 2. Department of Health and Human Services. Bone Health and Osteoporosis: a report of the the Surgeon General. Rockville, Md.: Office of the Surgeon General, 2004. 3. National Institute for Statistics. Italian Statistics 2005. Rome: National Institute for Statistics; 2005.