| Objective To explore the risk factors of re-fracture in patients with osteoporotic fractures, and to evaluate the value of serum bone alkaline phosphatase (BALP) as a prognostic indicator in patients with re-fractures. Methods A prospective cohort study including 178 patients, who were over 50 years old and diagnosed with osteoporotic fractures and in our hospital, was performed. The serum levels of BALP, calcium, and phosphorus were determined at the time with initial fracture. The bone mineral density (BMD) was detected. And other clinical general data were also collected and analyzed. All the patients were followed up for 4 years. The occurrence of re-fracture or death was defined as end-point event. Kaplan-Meier analysis and multivariate Cox regression model were used for the analysis of risk factors. Receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of BALP. Results Among all these 178 patients, 30 (16.9%) had re-fractures in 4 years. Cox regression analysis showed that BALP level, age, gender, and BMD were independent and important factors for re-fracture. Using BALP as a forecast standard, the ROC area under the curve (AUC) was 0.757, and diagnose critical point was 29.0μg/L. The sensitivity and specificity were 84.3% and 63.8%, respectively. Kaplan-Meier analysis revealed that patients with serum BALP > 29.0μg/L had a higher re-fracture incidence than patients with serum BALP ≤ 29.0μg/L (P=0.026). Conclusion The prevalence of second fracture is high in patients with osteoporotic fractures. The serum BALP level is an effective and suitable predictor. |