Previous fractures at multiple sites increase the risk for subsequent fractures: The global longitudinal study of osteoporosis in women

Abstract

Previous fractures of the hip, spine, or wrist are well-recognized predictors of future fracture, but the role of other fracture sites is less clear. We sought to assess the relationship between prior fracture at 10 skeletal locations and incident fracture. The Global Longitudinal Study of Osteoporosis in Women (GLOW) is an observational cohort study being conducted in 17 physician practices in 10 countries. Women ≥ 55 years answered questionnaires at baseline and at 1 and/or 2 years (fractures in previous year). Of 60,393 women enrolled, follow-up data were available for 51,762. Of these, 17.6%, 4.0%, and 1.6% had suffered 1, 2, or ≥3 fractures since age 45. During the first 2 years of follow-up, 3149 women suffered 3683 incident fractures. Compared with women with no prior fractures, women with 1, 2, or ≥ 3 prior fractures were 1.8-, 3.0-, and 4.8-fold more likely to have any incident fracture; those with ≥3 prior fractures were 9.1-fold more likely to sustain a new vertebral fracture. Nine of 10 prior fracture locations were associated with an incident fracture. The strongest predictors of incident spine and hip fractures were prior spine fracture (hazard ratio 7.3) and hip (hazard ratio 3.5). Prior rib fractures were associated with a 2.3-fold risk of subsequent vertebral fracture, previous upper leg fracture predicted a 2.2-fold increased risk of hip fracture; women with a history of ankle fracture were at 1.8-fold risk of future fracture of a weight-bearing bone. Our findings suggest that a broad range of prior fracture sites are associated with an increased risk of incident fractures, with important implications for clinical assessments and risk model development.

Differing risk profiles for individual fracture sites: Evidence from the global longitudinal study of osteoporosis in women (GLOW)

“…A study that compared radiographs to self-report of rib fracture estimated that 23% of self-reported rib fractures were not clinical fractures. (14) However, prior self-reported rib fracture, despite possible overreporting, was found predictive of future non-rib fracture in both the GLOW study (15) and the National Osteoporosis Risk Assessment (NORA). (16) Some unknown degree of misclassification of certain outcomes and risk factors therefore exists in GLOW, making it more difficult to derive accurate models, and biasing results toward the null hypothesis of no association between risk factor and fracture.…”

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

“…Given that there is a strong relationship between frailty and fractures that is independent of age [2], these residents are at high risk for fractures due to frailty-related risk factors. Residents of LTC who had a fracture while living in the community have been found to be at greater risk of both entering LTC [9] and having a future hip fracture [18,21].…”

The Role of the Physician in the Detection and Treatment of Osteoporosis in Patients With Fractures of the Radius

“…К настоящему времени имеются доказательства, что ПДОП является проявлением ОП и фактором риска после-дующих переломов [5,6,7,8]. Вместе с тем, как видно из ре-зультатов настоящего исследования, денситометрия прово-дится только у 3%-5,8% пациентов, перенесших ПДОП, ди-агностируется ОП менее чем у 20% пациентов, не учитыва-ются другие факторы риска, игнорируется тот факт, что до настоящего перелома уже были переломы костей при низ-ком уровне травмы.…”

“…Кроме того, во многих исследованиях показано, что ПДОП является важным прогностическим фактором ри-ска последующих переломов [5,6], в том числе переломов по-звонков и проксимального отдела бедра [7,8], что должно на-целивать врачей и пациентов на диагностику и лечение ОП после ПДОП. Вместе с тем, диагностика и лечение ОП оста-ются неудовлетворительными, и большинство пациентов по-сле низкоэнергетических переломов остаются без соответ-ствующего лечения.…”