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Imminent risk of fracture after fracture

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Abstract

Summary

The risk of major osteoporotic fracture (MOF) after a first MOF is increased over the whole duration of follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner.

Introduction

A history of fracture is a strong risk factor for future fractures. The aim of the present study was to determine whether the predictive value of a past MOF for future MOF changed with time.

Methods

The study was based on a population-based cohort of 18,872 men and women born between 1907 and 1935. Fractures were documented over 510,265 person-years. An extension of Poisson regression was used to investigate the relationship between the first MOF and the second. All associations were adjusted for age and time since baseline.

Results

Five thousand thirty-nine individuals sustained one or more MOFs, of whom 1919 experienced a second MOF. The risk of a second MOF after a first increased by 4% for each year of age (95% CI 1.02–1.06) and was 41% higher for women than men (95% CI 1.25–1.59). The risk of a second MOF was highest immediately after the first fracture and thereafter decreased with time though remained higher than the population risk throughout follow-up. For example, 1 year after the first MOF, the risk of a second fracture was 2.7 (2.4–3.0) fold higher than the population risk. After 10 years, this risk ratio was 1.4 (1.2–1.6). The effect was more marked with increasing age.

Conclusions

The risk of MOF after a first MOF is increased over the whole follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner, particularly in the elderly.

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Acknowledgements

We thank the participants in the Reykjavik Study for their valuable contribution.

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Authors and Affiliations

  1. Institute for Health and Aging, Australian Catholic University, Melbourne, Australia

    H. Johansson & J. A. Kanis

  2. Icelandic Heart Association, Kopavogur, Iceland

    K. Siggeirsdóttir, V. Gudnason & G Sigurdsson

  3. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    N. C. Harvey

  4. NIHR Southampton Biomedical Research Centre, University of Southampton and University, Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK

    N. C. Harvey

  5. Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK

    A. Odén, E. McCloskey & J. A. Kanis

  6. University of Iceland, Reykjavik, Iceland

    V. Gudnason

Authors
  1. H. Johansson
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  2. K. Siggeirsdóttir
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  3. N. C. Harvey
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  4. A. Odén
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  5. V. Gudnason
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  6. E. McCloskey
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  7. G Sigurdsson
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  8. J. A. Kanis
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Corresponding author

Correspondence to J. A. Kanis.

Ethics declarations

The study was approved by the National Bioethics Committee and the Data Protection Authority in Iceland. All participants gave informed written consent.

Conflicts of interest

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Johansson, H., Siggeirsdóttir, K., Harvey, N.C. et al. Imminent risk of fracture after fracture. Osteoporos Int 28, 775–780 (2017). https://doi.org/10.1007/s00198-016-3868-0

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  • DOI: https://doi.org/10.1007/s00198-016-3868-0

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