Hip Fracture Patients at Risk of Second Hip Fracture: A Nationwide Population-Based Cohort Study of 169,145 Cases During 1977–2001

Ryg, Jesper; Rejnmark, Lars; Overgaard, Søren; Brixen, Kim; Vestergaard, Peter

doi:10.1359/jbmr.090207

Cited by 252 publications

(215 citation statements)

References 72 publications

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“…The same relative risks were found in men and women, though the absolute risk was higher in women. 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%

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%

Imminent risk of fracture after fracture

et al. 2016

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“…(24)(25)(26)(27)(28)(29)(30)(31) Therapeutic agents that reduce fracture risk rapidly are desirable for these patients.…”

Section: Goal-directed Selection Of Initial Therapymentioning

confidence: 99%

Goal-Directed Treatment for Osteoporosis: A Progress Report From the ASBMR-NOF Working Group on Goal-Directed Treatment for Osteoporosis

Cummings

Cosman

Lewiecki

et al. 2016

Journal of Bone and Mineral Research

133

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The American Society for Bone and Mineral Research and the United States National Osteoporosis Foundation (NOF) formed a working group to develop principles of goal-directed treatment and identify gaps that need to be filled to implement this approach. With goaldirected treatment, a treatment goal would first be established and choice of treatment determined by the probability of achieving that goal. Goals of treatment would be freedom from fracture, a T-score > -2.5, which is above the NOF threshold for initiating treatment, or achievement of an estimated risk level below the threshold for initiating treatment. Progress toward reaching the patient's goal would be periodically and systematically assessed by estimating the patient's compliance with treatment, reviewing fracture history, repeating vertebral imaging when indicated, and repeating measurement of bone mineral density (BMD). Using these data, a decision would be made to stop, continue, or change therapy. Some of these approaches can now be applied to clinical practice. However, the application of goal-directed treatment cannot be fully achieved until medications are available that provide greater increases in BMD and greater reduction in fracture risk than those that are currently approved; only then can patients with very high fracture risk and very low BMD achieve such goals. Furthermore, assessing future fracture risk in patients on treatment requires a new assessment tool that accurately captures the change in fracture risk associated with treatment and should also be sensitive to the importance of recent fractures as predictors of imminent fracture risk. Lastly, evidence is needed to confirm that selecting and switching treatments to achieve goals reduces fracture risk more effectively than current standard care.

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“…Так, доведеними факторами ризику переломів ПВСК вважають вік старше від 65 років, належність до жі-ночої статі, попередні переломи в анамнезі, схиль-ність до падінь, сімейний анамнез переломів ПВСК, тривалий прийом глюкокортикоїдів, зловживання алкоголем, дефіцит вітаміну D та наявність деяких соматичних захворювань, зокрема паркінсонізму, цукрового діабету ІІ типу, ревматоїдного артриту та ін. [3,[13][14][15][16][17][18][19][20].…”

Section: âñòóïunclassified

“…Розподіл показника 10-річної ймовірності переломів стегнової кістки в чоловіків та жінок до перелому ПВСК вікових груп більш часто зустрічаються переломи кісток передпліччя, зокрема переломи Колліса, а переломи тіл хребців більш характерні для осіб літного віку. Обидва види переломів у декілька разів збільшують частоту по-вторних переломів, а також інших остеопоротичних пе-реломів [16][17][18][19].…”

Section: îáãîâîðåííÿunclassified

“…У 25,8 % хворих встановлено попередні переломи тіл хребців, 12,1 % -переломи плечової кістки, а в 3 хворих (4,5 %) -повторний перелом ПВСК конт-ралатеральної кінцівки. Подібні результати виявлені й у інших дослідженнях [16][17][18][19], що підтверджують гіпо-тезу щодо каскаду остеопоротичних переломів у жінок старших вікових груп.…”

Section: îáãîâîðåííÿunclassified

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