Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture

Abstract

SummaryThe absolute 5-year risk of subsequent non-vertebral fractures (NVFs) in 1,921 patients presenting with a NVF was 17.6% and of mortality was 32.3%. These risks were highest within the first year, indicating the need to study which reversible factors can be targeted to immediately minimise subsequent fracture risk and mortality.IntroductionNVFs are the most frequent clinical fractures in patients presenting at the emergency unit because of a clinical fracture. The aim of the study was to determine the 5-year absolute risk (AR) of subsequent NVF and mortality in patients at the time they present with a NVF.MethodsBetween 1999 and 2001, 1,921 consecutive patients 50+ years from a level 1 trauma centre were included. All NVFs were confirmed on radiograph reports, and mortality was checked in the national obituary database. Available potential risk factors for a subsequent NVF and mortality (age, sex and baseline fracture location: major—hip, pelvis, multiple ribs, proximal tibia/humerus and distal femur; minor—all others) were expressed as hazard ratios (HR) with 95% confidence intervals (CI) using multivariable Cox regression analysis.ResultsThe AR for a subsequent NVF was 17.6% and was related to age (HR per decade, 1.44; 95%CI, 1.29–1.60). The AR for mortality was 32.3% and was related to age (HR per decade, 2.59; 95%CI, 2.37–2.84), male sex (HR, 1.74; 95%CI, 1.44–2.10), major fracture at baseline (HR, 5.56; 95%CI, 3.48–8.88; not constant over time) and subsequent fracture (HR, 1.65; 95%CI, 1.33–2.05). The highest risks were found within the first year (NVFs, 6.4%; mortality, 12.2%) and were related to age and, in addition, to baseline fracture location for mortality.ConclusionsWithin 5 years after an initial NVF, nearly one in five patients sustained a subsequent NVF and one in three died. One third of subsequent NVFs and mortality occurred within 1 year, indicating the need to study which reversible factors can be targeted to immediately prevent subsequent fractures and mortality.

The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location, and ethnicity

“…The remaining lifetime risk for sustaining any fracture from the age of 50 years has been estimated to be as high as 53% among women and 21% among men in the United Kingdom [1]. The increased risk of death following hip and spinal fractures is well established, and emerging evidence shows that other fracture types are also associated with increased mortality rates [2][3][4]. The excess mortality is highest for fractures of the hip, where the risk of death is twice that of the general population of the same age, and is even higher among men (3-4 fold higher risk in the first year compared to the general population) [5,6].…”

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“…It is the most common musculoskeletal disease in humans and has a growing impact on the public health systems of developed countries due to their aging populations [1][2][3][4][5][6] .…”

Fracture — A Risk Factor for Development and Progression of Osteopenia and Osteoporosis

“…Пристального внимания заслуживают травматиче-ские повреждения опорно-двигательной системы, вы-ступающие как фактор риска развития посттравмати-ческой остеопении, остеопороза и в последующем -перелома [9,23,37,39,40,62,70,72]. В соответствии с рекомендациями 2013 года Национального фонда остеопороза (NOF) лица, имеющие перелом в анамне-зе, входят в группу повышенного риска по остеопоро-зу [22].…”