Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug;29(8):1747-1757.
doi: 10.1007/s00198-018-4502-0. Epub 2018 Jun 12.

Characteristics of recurrent fractures

J A Kanis  1   2 , H Johansson  3   4 , A Odén  3 , N C Harvey  5   6 , V Gudnason  7   8 , K M Sanders  4 , G Sigurdsson  7 , K Siggeirsdottir  7 , L A Fitzpatrick  9 , F Borgström  10 , E V McCloskey  3   11
Affiliations

Characteristics of recurrent fractures

J A Kanis et al. Osteoporos Int. 2018 Aug.

Abstract

The present study, drawn from a sample of the Icelandic population, quantified high immediate risk and utility loss of subsequent fracture after a sentinel fracture (at the hip, spine, distal forearm and humerus) that attenuated with time.

Introduction: The risk of a subsequent osteoporotic fracture is particularly acute immediately after an index fracture and wanes progressively with time. The aim of this study was to quantify the risk and utility consequences of subsequent fracture after a sentinel fracture (at the hip, spine, distal forearm and humerus) with an emphasis on the time course of recurrent fracture.

Methods: The Reykjavik Study fracture registration, drawn from a sample of the Icelandic population (n = 18,872), recorded all fractures of the participants from their entry into the study until December 31, 2012. Medical records for the participants were manually examined and verified. First sentinel fractures were identified. Subsequent fractures, deaths, 10-year probability of fracture and cumulative disutility using multipliers derived from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) were examined as a function of time after fracture, age and sex.

Results: Over 10 years, subsequent fractures were sustained in 28% of 1498 individuals with a sentinel hip fracture. For other sentinel fractures, the proportion ranged from 35 to 38%. After each sentinel fracture, the risk of subsequent fracture was highest in the immediate post fracture interval and decreased markedly with time. Thus, amongst individuals who sustained a recurrent fracture, 31-45% did so within 1 year of the sentinel fracture. Hazard ratios for fracture recurrence (population relative risks) were accordingly highest immediately after the sentinel fracture (2.6-5.3, depending on the site of fracture) and fell progressively over 10 years (1.5-2.2). Population relative risks also decreased progressively with age. The utility loss during the first 10 years after a sentinel fracture varied by age (less with age) and sex (greater in women). In women at the age of 70 years, the mean utility loss due to fractures in the whole cohort was 0.081 whereas this was 12-fold greater in women with a sentinel hip fracture, and was increased 15-fold for spine fracture, 4-fold for forearm fracture and 8-fold for humeral fracture.

Conclusion: High fracture risks and utility loss immediately after fracture suggest that treatment given as soon as possible after fracture would avoid a higher number of new fractures compared with treatment given later. This provides the rationale for very early intervention immediately after a sentinel fracture.

Keywords: Fracture probability; Imminent risk; Sentinel fracture; Utility loss.

PubMed Disclaimer

Conflict of interest statement

Competing interest

Radius Health, Inc., was the sponsor for this study and provided financial support for its completion. LF is an employee of Radius Health. None of the other authors declare competing interests with regard to this paper.

Figures

Figure 1
Figure 1
Time course of recurrent fractures in men and women following individual sentinel fractures, expressed as a percentage of all those experiencing recurrent fractures.
Figure 2
Figure 2
Hazard ratio (sentinel fracture compared with the whole cohort) of osteoporotic fracture in women at the age of 70 years by time according to the site of sentinel fracture
Figure 3
Figure 3
Cumulative utility loss for men and women at ages shown after vertebral fracture
See this image and copyright information in PMC

Comment in

References

    1. Johnell O, Kanis JA, Oden A, et al. Fracture risk following an osteoporotic fracture. Osteoporos Int. 2004;15:175–179. - PubMed
    1. Hansen L, Petersen KD, Eriksen SA, et al. Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int. 2015;26:513–9. - PubMed
    1. Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35:375–382. - PubMed
    1. Haentjens P, Johnell O, Kanis JA, et al. Gender-related differences in short and long-term absolute risk of hip fracture after Colles’ or spine fracture: Colles’ fracture as an early and sensitive marker of skeletal fragility in men. J Bone Miner Res. 2004;19:1933–1944. - PubMed
    1. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15:721–739. - PubMed

LinkOut - more resources