Fragility Fracture Incidence and Risk in Patients Who Undergone Bone Mineral Density Testing in Qatar: A Retrospective Cohort Study

Abstract

Background: Osteoporosis and its associated fragility fractures pose a significant public health issue in the elderly population. Additionally, diabetes has been linked to an increased risk of fragility fractures. In Qatar, little is known about the burden of fragility fractures and their association with osteoporosis or diabetes. Aims: Determining the burden of incident fragility fractures, following a bone mineral density (BMD) test, and the effects of having lower BMD levels and being diabetic on the risk of fragility fractures in the population aged fifty and older. Additionally, assessing the impact of database selection for the BMD reference range used to establish osteoporosis diagnosis on fracture risk estimates in the Qatari women subpopulation. Methods: In this retrospective hospital-based cohort study, patients who underwent BMD testing between May 2016 and June 2019 were followed through their health records from the date of the first test until the first fracture or their last encounter (before April 2020), whichever came first. The incidence rate of fractures per 1000 personmonths of follow-up was estimated. Univariate and multivariate Cox proportional hazards regression analyses were performed to determine the effect of BMD and the effect of diabetes on fracture-free survival. Fracture rates among patients with osteoporosis and sensitivity for detecting incident fractures were estimated and compared using the National Health and Nutrition Examination Survey (NHANES) and the Qatari databases. Results: The cohort consisted of 705 patients who had a median follow-up time of 31.03 months (IQR=12.05). The incidence rate was 1.73 (95% CI= (1.23-2.42)). The crude hazard ratio (HR) for fragility fracture per standard deviation reduction in BMD was 1.82 (95% CI= (1.34-2.48)) and 1.93 (95% CI= (1.37-2.71)) when adjusted for age and gender. Compared to not being diabetic, HR for being diabetic was 1.36 (95% CI= (0.69-2.68)). Using the NHANES database yielded higher incidence rates among female patients with osteoporosis and more sensitivity in detecting incident fracture. Conclusion: Among older adults, BMD is a significant predictor for fragility fractures, and the association between diabetes and fractures remains equivocal. The NHANES database is superior to the Qatari database in detecting incident fracture cases among older Qatari women.