Abstract

Introduction: Vertebral fragility fractures are the most common fragility fracture. A significant proportion of patients still present to hospital for treatment due to their underlying older age and frailty syndrome. We aim to describe the prevalence of frailty within a cohort of hospitalised patients with vertebral fragility fracture using clinical frailty scales and comparing this group of patients with those that have a fragility fracture of the hip, a well-recognised frail group of patients.

Method: As part of a service improvement project, a prospective case series of all patients ≥50years admitted to hospital with a vertebral fragility fracture over a 6 week period (n=24) were screened for frailty. This was done using recognised clinical scales for frailty assessment (PRISMA-7, Groningen Frailty Index(GFI) and Edmonton Frail Scale (EFS)). Data was collected on patients’ mobility (timed-up-and-go test), activities of daily living (Barthel Index) and cognition (abbreviated mental test). Secondly, we performed a cross-sectional analysis of patient characteristics of those ≥50years admitted to hospital with a fragility fracture of the hip (n=30) and those with a vertebral fragility fracture using data from our local clinical service registries.

Results: In the first study, frailty was identified in 70.8% of vertebral fracture patients using PRISMA-7 tool; 66.7% with the GFI; and 33.3% with the EFS. A further 20.8% were considered vulnerable to frailty on the EFS. Almost 30% were considered frail on all the three scales. Three quarters had a timed-up-and-go of >20seconds. Median Barthel Index was 18 (range 6-20); and the median abbreviated mental test was 9 (range 2-10), which suggests a cohort that is mostly independent with personal activities of daily living with good levels of cognition. In the second study, compared to patients with hip fracture, patients with vertebral fractures were younger; more likely to be living independently; less likely to have fallen in the last year; were taking more medication; and had equal number of co-morbidities as patients with hip fractures

Conclusion: Frailty is prevalent in those admitted to hospital with a vertebral fragility fracture. Treatment of their acute fracture will need to include addressing their frailty issues.

Keywords: Osteoporosis, vertebral fracture, frailty, hospital, ageing.

Graphical Abstract