Clinical subsequent fractures cluster in time after first fractures

Geel, Tineke van; Helden, Svenhjalmar van; Geusens, Piet; Winkens, Björn; Dinant, Geert‐Jan

doi:10.1136/ard.2008.092775

Cited by 236 publications

(124 citation statements)

References 15 publications

(11 reference statements)

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“…This transient phenomenon will be missed in long-term follow-up studies where the pattern of risk with time is not studied [2,[19][20][21]. Several previous studies have found that a recent occurrence of fracture was a greater risk factor for subsequent fracture than a history of earlier fracture, demonstrated for vertebral fracture [6,11], hip, humeral and forearm fractures [3,6] and all fractures combined [12].…”

Section: Discussionmentioning

confidence: 99%

“…For example, a large meta-analysis showed that a prior fracture history was a significant risk factor for hip fracture at all ages but was highest at younger ages and decreased progressively with age [3]. Several studies have examined the time course of second fractures by site following an index fracture [6][7][8][9][10][11][12]. Fracture at the hip, forearm, spine or humerus (collectively termed major osteoporotic fractures) have been less frequently studied but (apart from rib fractures) comprise approximately 90% of the morbidity due to fracture [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Imminent risk of fracture after fracture

et al. 2016

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Objectives-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 major osteoporotic fracture (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-5039 individuals sustained one or more MOF, 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 and 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Imminent risk of fracture after fracture

et al. 2016

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“…Another shortcoming is that FRAX does not take into account the clustering of fractures in time, ie the risk of subsequent fractures after a first fracture is highest during the first years after a fracture, although the increased risk persists over longer time, be it at a lower level than immediately after a fracture. This has been documented for repeat vertebral, non-vertebral and all clinical fractures and recently also for repeat hip fractures van Geel et al 2009;Center et al 2007;van Helden et al 2006]. Ryg et al reported clustering of repeat hip fractures in a nation-wide registrar in Denmark including nearly 170,000 first and nearly 28,000 second hip fractures ( Figure 5) .…”

Section: Clinical Risk Factors For Hip Fracturementioning

confidence: 99%

Can hip fracture prediction in women be estimated beyond bone mineral density measurement alone?

Geusens

Geel

Bergh

2010

Therapeutic Advances in Musculoskeletal

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The etiology of hip fractures is multifactorial and includes bone and fall-related factors. Low bone mineral density (BMD) and BMD-related and BMD-independent geometric components of bone strength, evaluated by hip strength analysis (HSA) and finite element analysis analyses on dual-energy X-ray absorptiometry (DXA) images, and ultrasound parameters are related to the presence and incidence of hip fracture. In addition, clinical risk factors contribute to the risk of hip fractures, independent of BMD. They are included in the fracture risk assessment tool (FRAX) case finding algorithm to estimate in the individual patient the 10-year risk of hip fracture, with and without BMD. Fall risks are not included in FRAX, but are included in other case finding tools, such as the Garvan algorithm, to predict the 5-and 10-year hip fracture risk. Hormones, cytokines, growth factors, markers of bone resorption and genetic background have been related to hip fracture risk. Vitamin D deficiency is endemic worldwide and low serum levels of 25-hydroxyvitamin D [25(OH)D] predict hip fracture risk. In the context of hip fracture prevention calculation of absolute fracture risk using clinical risks, BMD, bone geometry and fall-related risks is feasible, but needs further refinement by integrating bone and fall-related risk factors into a single case finding algorithm for clinical use.

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“…The studies included by Klotzbuecher et al 149 in the meta-analysis had varying durations of follow-up, but generally > 1 year, so the estimates provided by Klotzbuecher et al 149 represent the RR when averaged over all years of study follow-up. The temporal profile of increased fracture risk after an incident fracture has been studied by van Geel et al 214 Their analysis suggests that the RR is approximately 2 when averaged over the long term, but when assessed over different time periods is much higher immediately after the first fracture, and tails off towards 1 over the next 20 years. We acknowledge that our method of applying a fixed RR over the patient's remaining lifetime probably underestimates the increased risk in the immediate years after fracture, but it is likely to overestimate the increased risk in the long term.…”

mentioning

confidence: 99%

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

Davis

James

Sanderson

et al. 2018

Health Technol Assess

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During the course of providing additional analyses for the National Institute for Health and Care Excellence Technology Appraisal Committee, two errors were identified in the data entered in the network meta-analysis that informed the cost-effectiveness analysis described in the original report. This corrigendum notice describes the errors identified and the impact of correcting these errors on the main analyses presented in the original report.

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Clinical subsequent fractures cluster in time after first fractures

Abstract: From menopause onwards, clinical fractures cluster in time, indicating the need for early action to prevent subsequent fractures.

Cited by 236 publications

References 15 publications

Imminent risk of fracture after fracture

Imminent risk of fracture after fracture

Can hip fracture prediction in women be estimated beyond bone mineral density measurement alone?

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

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