Analysis of related factors of primary and recurrent fractures in postmenopausal osteoporotic patients: A Retrospective Study

Abstract Objective: To analyze the factors associated with primary and recurrent fractures in Chinese postmenopausal women with osteoporosis.Methods: A retrospective analysis of 2478 postmenopausal osteoporosis (PMOP) patients who attended the Shanghai General Hospital from January 2007 to December 2016, including 1239 patients with no fractures and 1239 patients with a history of fracture (1008 in the primary fracture group and 231 in the re-fracture group). All patients' basic clinical data, serum biochemical and bone metabolic markers, bone mineral density (BMD), and other indicators were recorded uniformly. SPSS.26 was used for statistical analysis.Results: 1. Compared with the non-fractured group, the fractured group had higher age, lower height, and lower bone mineral density (all P<0.01). The re-fractured group had lower bone mineral density than the primary fracture group at each key site (all P<0.01). 2. Analysis of the combined disease subgroups showed that: 1) the serum BGP level was lower in the subgroup with diabetes in the primary fracture group than in the subgroup without diabetes (P<0.05). 2) The recurrent fracture group with diabetes had lower serum CTX and BGP levels than the subgroup without diabetes (P<0.05); the subgroup with cardio-cerebrovascular diseases had lower bone mineral density than the subgroup without cardio-cerebrovascular diseases (P<0.05); 3) In the subgroup with diabetes, the subgroup with recurrent fracture had lower serum CTX levels than the subgroup with primary fracture (P<0.05); in the subgroup with cardio-cerebrovascular diseases, the subgroup with recurrent fracture had lower bone mineral density than the subgroup with primary fracture. 3. Multiple logistic regression analysis showed that advanced age, overweight, low lumbar spine and total hip BMD, and combined chronic liver and kidney diseases were independent risk factors for primary fractures; advanced age, overweight, low lumbar spine and total hip BMD were independent risk factors for recurrent fractures. Conclusion: Postmenopausal osteoporotic patients with advanced age, overweight, low bone mineral density, and comorbid chronic liver and kidney diseases are at greater risk of fractures and require early intervention to reduce fractures occurrence. Moreover, those who are elderly, overweight, and have low bone density should also be aware of the risk of re-fractures.