Risk of Subsequent Fracture After Low-Trauma Fracture in Men and Women

Abstract

ContextThere are few published long-term data on absolute risk of subsequent fracture (refracture) following initial low-trauma fracture in women and fewer in men.Objective To examine long-term risk of subsequent fracture following initial osteoporotic fracture in men and women.Design, Setting, and Participants Prospective cohort study (Dubbo Osteoporosis Epidemiology Study) in Australia of 2245 community-dwelling women and 1760 men aged 60 years or older followed up for 16 years from July 1989 through April 2005.Main Outcome Measure Incidence of first (initial) fracture and incidence of subsequent fracture according to sex, age group, and time since first fracture. Relative risk was determined by comparing risk of subsequent fracture with risk of initial fracture.Results There were 905 women and 337 men with an initial fracture, of whom 253 women and 71 men experienced a subsequent fracture. Relative risk (RR) of subsequent fracture in women was 1.95 (95% confidence interval [CI], 1.70-2.25) and in men was 3.47 (95% CI, 2.68-4.48). As a result, absolute risk of subsequent fracture was similar in women and men and at least as great as the initial fracture risk for a woman 10 years older. Thus, women and men aged 60 to 69 years had absolute refracture rates of 36/1000 person-years (95% CI, 26-48/1000) and 37/1000 personyears (95% CI, 23-59/1000), respectively. The increase in absolute fracture risk remained for up to 10 years, by which time 40% to 60% of surviving women and men experienced a subsequent fracture. All fracture locations apart from rib (men) and ankle (women) resulted in increased subsequent fracture risk, with highest RRs following hip (RR, 9.97; 95% CI,) and clinical vertebral (RR,15.12; 95% CI, 6.06-37.69) fractures in younger men. In multivariate analyses, femoral neck bone mineral density, age, and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density, physical activity, and calcium intake were predictors in men. ConclusionAfter an initial low-trauma fracture, absolute risk of subsequent fracture was similar for men and women. This increased risk occurred for virtually all clinical fractures and persisted for up to 10 years.

Mortality and re-fracture rates in low trauma hip fracture

“…We found that the re-fracture incidence rate was higher in women than in men. This finding is consistent with most of the available reports [ 37 , 38 ]. The density of bone mass decreases more in women than in men beyond the reproductive age because of menopause which increases the frequency of falls and re-fractures.…”

Long-term refracture and mortality assessment in fractured elderly individuals: an evidence-based analysis based on T.A.R.Ge.T data

“…At the end of follow-up, less than 30% of the initial cohort was alive and without any refracture, a pattern that seemed more marked in males than in females. Our results are in line with those of previous studies indicating a higher risk of refracture among females than males, but a higher rate of fatal outcomes among males [9][10][11][12][13] . Compared with a previous study [14] in which the same strategy of analysis was used, our findings indicated slightly higher mortality (67% males and 47% females) at 5 years from the index fracture.…”

Is Withholding Osteoporosis Medication After Fracture Sometimes Rational? A Comparison of the Risk for Second Fracture Versus Death

“…Our results are compatible with prior literature showing a substantial mortality after hip and vertebral fractures (25–28). As we found, this risk has been shown to vary over time, with a greater risk both for mortality and second fracture occurring within the first 6–24 months after the first fracture (28).…”