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. 2020 Jun;31(6):1059-1067.
doi: 10.1007/s00198-019-05274-2. Epub 2020 Mar 16.

Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study

W D Leslie  1 , J T Schousboe  2   3 , S N Morin  4 , P Martineau  5   6 , L M Lix  5 , H Johansson  7   8 , E V McCloskey  7   9 , N C Harvey  10   11 , J A Kanis  7   8
Affiliations

Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study

W D Leslie et al. Osteoporos Int. 2020 Jun.

Abstract

Prior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma.

Introduction: Some have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures.

Methods: Using a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise.

Results: The study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08-1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47-1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture.

Conclusions: High-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk.

Keywords: Dual-energy X-ray absorptiometry; Fractures; Osteoporosis; Trauma.

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Conflict of interest statement

Disclosures:

Suzanne Morin: Nothing to declare for the context of this paper, but has received research grants: Amgen, Merck.

Eugene McCloskey: Nothing to declare for the context of this paper, but numerous ad hoc consultancies/ speaking honoraria and/or research funding from Amgen, Bayer, General Electric, GSK, Hologic, Lilly, Merck Research Labs, Novartis, Novo Nordisk, Nycomed, Ono, Pfizer, ProStrakan, Roche, Sanofi-Aventis, Servier, Tethys, UBS and Warner-Chilcott

Nicholas Harvey: Nothing to declare for the context of this paper, but has received consultancy/ lecture fees/ honoraria/ grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare, Radius Health, Kyowa Kirin and Internis Pharma.

John A. Kanis: Grants from Amgen, Lilly, Radius Health and non-financial support from Medimaps outside the submitted work

William Leslie, Patrick Martineau, Lisa Lix, Helena Johansson: No conflicts of interest.

Figures

Figure 1
Figure 1. Kaplan-Meier curves for fracture-free survival according to number of self-reported falls in the previous year.
See this image and copyright information in PMC

Comment in

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