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Osteoporos Int. 2018 Nov 19. doi: 10.1007/s00198-018-4732-1. [Epub ahead of print]

Risk of subsequent fracture after prior fracture among older women.

Author information

1
Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA. akhilab@amgen.com.
2
University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294, USA.
3
Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
4
Wenkert & Young, LLC, 2345 Mountain Crest Circle, Thousand Oaks, CA, 91362, USA.

Abstract

Among 377,561 female Medicare beneficiaries who sustained a fracture, 10% had another fracture within 1 year, 18% within 2 years, and 31% within 5 years. Timely management to reduce risk of subsequent fracture is warranted following all nontraumatic fractures, including nonhip nonvertebral fractures, in older women.

INTRODUCTION:

Prior fracture is a strong predictor of subsequent fracture; however, postfracture treatment rates are low. Quantifying imminent (12-24 month) risk of subsequent fracture in older women may clarify the need for early postfracture management.

METHODS:

This retrospective cohort study used Medicare administrative claims data. Women ≥ 65 years who sustained a clinical fracture (clinical vertebral and nonvertebral fracture; index date) and were continuously enrolled for 1-year pre-index and ≥ 1-year (≥  2 or ≥ 5 years for outcomes at those time points) post-index were included. Cumulative incidence of subsequent fracture was calculated from 30 days post-index to 1, 2, and 5 years post-index. For appendicular fractures, only those requiring hospitalization or surgical repair were counted. Death was considered a competing risk.

RESULTS:

Among 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5 years post-index, respectively. Among women age 65-74 years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women ≥ 75 years regardless of initial fracture site (except ankle and tibia/fibula), 7-14% fractured again within 1 year depending on initial fracture site; risk rose to 15-26% within 2 years and 28-42% within 5 years. Risk of subsequent hip fracture exceeded 3% within 5 years in all women studied, except those < 75 years with an initial tibia/fibula or ankle fracture.

CONCLUSIONS:

We observed a high and early risk of subsequent fracture following a broad array of initial fractures. Timely management with consideration of pharmacotherapy is warranted in older women following all fracture types evaluated.

KEYWORDS:

Epidemiology; Fracture; Fracture risk assessment; Fragility; General population studies; Geriatric; Incidence; Major osteoporotic fracture; Osteoporosis; Postmenopausal; Prediction modeling; Prevalence; Refracture

PMID:
30456571
DOI:
10.1007/s00198-018-4732-1

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