Risk of imminent fracture following a previous fracture in a Swedish database study

Abstract

SummaryThis study examined the imminent risk of a future fracture within 1 and 2 years following a first fracture in women aged 50 years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures.IntroductionThis study aims to determine the imminent risk of subsequent fractures within 1 and 2 years following a first fracture and to assess independent factors associated with subsequent fractures.MethodsRetrospective, observational cohort study of women aged ≥ 50 years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24 months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis.ResultsTwo hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12 months was 7.1% (95% confidence interval [CI], 6.9–7.2) and at 24 months was 12.0% (95% CI, 11.8–12.1). The rate of subsequent fractures was highest in the first month (~ 15 fractures per 1000 patient-years) and remained steady between 4 and 24 months (~ 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24 months, sub-distribution hazard ratio [HR], 3.07; p < 0.001 for women 80–89 years [reference 50–59 years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p < 0.001 over 12 months; HR, 2.23; p < 0.001 over 24 months).ConclusionsOur findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.Electronic supplementary materialThe online version of this article (10.1007/s00198-019-04852-8) contains supplementary material, which is available to authorized users.

History of Previous Fracture and Imminent Fracture Risk in Swedish Women Aged 55 to 90 Years Presenting With a Fragility Fracture

“…Older patients were at higher risk of subsequent fracture and death following an index fracture, in line with predictive multivariate regression analyses reported elsewhere . Although average time between index and subsequent fracture type was not reported in this study, higher cumulative incidence of subsequent fracture is indicative of a shorter average time between index and subsequent fracture, suggesting that older patients are more likely to experience subsequent fractures, with less time between each fracture.…”

“…The increased risk of suffering a subsequent fracture is highest within the 2 years following the first fragility fracture, then declines . During this period, up to 25% of fracture patients will experience a subsequent fracture depending on the type of previous fracture, with vertebral fractures increasing risk the most . The marked elevation in risk seen in the 24 months following a fragility fracture as compared to lifetime risk is increasingly recognized and termed “imminent risk.”…”

Osteoporosis and Osteoporotic Fracture Fact Sheet in Korea

“…Although few studies have addressed the incidence of subsequent fracture, a recent study found that the overall cumulative incidence of subsequent fracture following an index fracture was 12% at 24 months. [28] Similarly, this present study has reported cumulative incidences for subsequent fracture of 12.1% and 24.8% during 24 and 48 months of follow-up in Korea, respectively, regardless of index fracture type, although vertebrae were most frequently affected by secondary fractures. Since subsequent fractures impose enormous socioeconomic burdens and have relatively high mortality rates, [29][30][31] it is important that patients with an osteoporotic fracture history be identified and provided proper management to prevent future fractures.…”

The Effect of 1 Year of Romosozumab on the Incidence of Clinical Vertebral Fractures in Postmenopausal Women With Osteoporosis: Results From the FRAME Study

“…(9) The incidence of another fragility fracture within the year following a clinical VFx has been recently shown to be approximately 16%. (19) This extremely high risk mandates that these fractures be rapidly identified so that appropriate therapies be commenced without delay. This matter has been the subject of several recommendations including a recent call-to-action endorsed by multiple international and national societies.…”

“…It is well known that VFxs substantially increase the risk of subsequent fractures, and lead to increased morbidity and mortality, as well as high costs . The incidence of another fragility fracture within the year following a clinical VFx has been recently shown to be approximately 16% . This extremely high risk mandates that these fractures be rapidly identified so that appropriate therapies be commenced without delay.…”