Risk analysis for subsequent fracture of osteoporotic fractures in Chinese women over age 60: a nationwide cross-sectional study

Abstract

Prevention of subsequent fracture is a major public health challenge in the field of osteoporosis prevention and treatment, and older women are at high risk for osteoporotic fractures. This study aimed to examine factors associated with subsequent fracture in older Chinese women with osteoporosis. We collected data on 9212 older female patients with osteoporotic fractures from 580 medical institutions in 31 provinces of China. Higher odds of subsequent fractures were associated with age of 70–79 years (OR 1.218, 95% CI 1.049–1.414), age ≥ 80 (OR 1.455, 95% CI 1.222–1.732), index fracture site was vertebrae (OR 1.472, 95% CI 1.194–1.815) and hip (OR 1.286, 95% CI 1.041–1.590), index fracture caused by fall (OR 1.822, 95% CI 1.281–2.591), strain (OR 1.587, 95% CI 1.178–2.139), no inducement (OR 1.541, 95% CI 1.043–2.277), and assessed as high risk of fracture (OR 1.865, 95% CI 1.439–2.416), BMD T-score ≤ −2.5 (OR 1.725, 95% CI 1.440–2.067), history of surgery (OR 3.941, 95% CI 3.475–4.471) and trauma (OR 8.075, 95% CI 6.941–9.395). Low risk of fall (OR 0.681, 95% CI 0.513–0.904), use of anti-osteoporosis medication (AOM, OR 0.801, 95% CI 0.693–0.926), and women who had received fall prevention health education (OR 0.583, 95% CI 0.465–0.730) associated with lower risk. The areas under the curve of the prediction model was 0.818. The sensitivity was 67.0% and the specificity was 82.0%. The prediction model showed a good ability to predict the risk of subsequent fracture in older women with osteoporotic fractures and are suitable for early self-measurement which may benefit post-fracture management.