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Osteoporos Int. 2017 Mar;28(3):775-780. doi: 10.1007/s00198-016-3868-0. Epub 2016 Dec 27.

Imminent risk of fracture after fracture.

Author information

1
Institute for Health and Aging, Australian Catholic University, Melbourne, Australia.
2
Icelandic Heart Association, Kopavogur, Iceland.
3
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
4
NIHR Southampton Biomedical Research Centre, University of Southampton and University, Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
5
Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
6
University of Iceland, Reykjavik, Iceland.
7
Institute for Health and Aging, Australian Catholic University, Melbourne, Australia. w.j.pontefract@sheffield.ac.uk.
8
Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK. w.j.pontefract@sheffield.ac.uk.

Abstract

The risk of major osteoporotic fracture (MOF) after a first MOF is increased over the whole duration of follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner.

INTRODUCTION:

A history of fracture is a strong risk factor for future fractures. The aim of the present study was to determine whether the predictive value of a past MOF for future MOF changed with time.

METHODS:

The study was based on a population-based cohort of 18,872 men and women born between 1907 and 1935. Fractures were documented over 510,265 person-years. An extension of Poisson regression was used to investigate the relationship between the first MOF and the second. All associations were adjusted for age and time since baseline.

RESULTS:

Five thousand thirty-nine individuals sustained one or more MOFs, of whom 1919 experienced a second MOF. The risk of a second MOF after a first increased by 4% for each year of age (95% CI 1.02-1.06) and was 41% higher for women than men (95% CI 1.25-1.59). The risk of a second MOF was highest immediately after the first fracture and thereafter decreased with time though remained higher than the population risk throughout follow-up. For example, 1 year after the first MOF, the risk of a second fracture was 2.7 (2.4-3.0) fold higher than the population risk. After 10 years, this risk ratio was 1.4 (1.2-1.6). The effect was more marked with increasing age.

CONCLUSIONS:

The risk of MOF after a first MOF is increased over the whole follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner, particularly in the elderly.

KEYWORDS:

Epidemiology; Iceland; Osteoporotic fracture; Poisson regression model; Second fracture

PMID:
28028554
PMCID:
PMC5338733
DOI:
10.1007/s00198-016-3868-0
[Indexed for MEDLINE]
Free PMC Article

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