Imminent risk of fracture after fracture
- PMID: 28028554
- PMCID: PMC5338733
- DOI: 10.1007/s00198-016-3868-0
Imminent risk of fracture after fracture
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.
Conflict of interest statement
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.
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- MC_U147585827/MRC_/Medical Research Council/United Kingdom
- 21231/ARC_/Arthritis Research UK/United Kingdom
- MC_U147585819/MRC_/Medical Research Council/United Kingdom
- 17702/ARC_/Arthritis Research UK/United Kingdom
- MC_UP_A620_1014/MRC_/Medical Research Council/United Kingdom
- MR/K006312/1/MRC_/Medical Research Council/United Kingdom
- MC_UU_12011/1/MRC_/Medical Research Council/United Kingdom
- HTA/10/33/04/DH_/Department of Health/United Kingdom
- MR/P020941/1/MRC_/Medical Research Council/United Kingdom
- G0400491/MRC_/Medical Research Council/United Kingdom
- MC_U147585824/MRC_/Medical Research Council/United Kingdom
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