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. 2017 Mar;28(3):775-780.
doi: 10.1007/s00198-016-3868-0. Epub 2016 Dec 27.

Imminent risk of fracture after fracture

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

Imminent risk of fracture after fracture

H Johansson et al. Osteoporos Int. 2017 Mar.

Abstract

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.

Keywords: Epidemiology; Iceland; Osteoporotic fracture; Poisson regression model; Second fracture.

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Conflict of interest statement

Competing Interests

H Johansson, K Siggeirsdóttir, NC Harvey, A Odén, V Gudnason, E McCloskey, G Sigurdsson and JA Kanis declare no competing interests with regard to the present study.

Figures

Fig. 1
Fig. 1
Risk per 100 000 (95% CI) of a second major osteoporotic fracture (MOF) after a first MOF for a woman at the age of 75 years at her first fracture. Knots for the spline function are set at 0.5, 2.5 and 15 years of follow up after the first fracture. The dashed line is the risk of first MOF in whole population (n=18,872) for a woman 75 years at baseline.
Fig. 2
Fig. 2
The effect of age on the risk of subsequent major osteoporotic fracture at 6, 24 and 60 months following a first major osteoporotic fracture. The hazard ratio (HR) compares the risk against that of the general population when allowing the population to age with time (e.g. the 80-year-old individual after 60 months is compared with the population age 85 years).
See this image and copyright information in PMC

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