Meta-Analysis

. 2023 Dec;34(12):2027-2045.

doi: 10.1007/s00198-023-06870-z. Epub 2023 Aug 11.

Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX

J A Kanis^{1

2}, H Johansson^{3

4}, E V McCloskey^{5

6}, E Liu³, K E Åkesson^{7

8}, F A Anderson⁹, R Azagra^{10

11

12}, C L Bager¹³, C Beaudart^{14

15}, H A Bischoff-Ferrari^{16

17}, E Biver¹⁸, O Bruyère¹⁴, J A Cauley¹⁹, J R Center^{20

21

22}, R Chapurlat²³, C Christiansen¹³, C Cooper^{24

25

26}, C J Crandall²⁷, S R Cummings²⁸, J A P da Silva^{29

30}, B Dawson-Hughes³¹, A Diez-Perez³², A B Dufour^{33

34}, J A Eisman^{20

21

22}, P J M Elders³⁵, S Ferrari¹⁸, Y Fujita³⁶, S Fujiwara³⁷, C-C Glüer³⁸, I Goldshtein^{39

40}, D Goltzman⁴¹, V Gudnason^{42

43}, J Hall⁴⁴, D Hans⁴⁵, M Hoff^{46

47}, R J Hollick⁴⁸, M Huisman^{49

50}, M Iki⁵¹, S Ish-Shalom⁵², G Jones⁵³, M K Karlsson^{7

8}, S Khosla⁵⁴, D P Kiel^{33

34}, W-P Koh^{55

56}, F Koromani^{57

58}, M A Kotowicz^{59

60

61}, H Kröger^{62

63}, T Kwok^{64

65}, O Lamy^{66

67}, A Langhammer⁶⁸, B Larijani⁶⁹, K Lippuner⁷⁰, D Mellström^{71

72}, T Merlijn⁷³, A Nordström^{74

75

76}, P Nordström⁷⁷, T W O'Neill^{78

79}, B Obermayer-Pietsch^{80

81}, C Ohlsson^{82

83}, E S Orwoll⁸⁴, J A Pasco^{59

60

61

85}, F Rivadeneira⁵⁷, A-M Schott⁸⁶, E J Shiroma⁸⁷, K Siggeirsdottir^{42

88}, E M Simonsick⁸⁹, E Sornay-Rendu⁹⁰, R Sund⁶³, K M A Swart^{35

91}, P Szulc⁹⁰, J Tamaki⁹², D J Torgerson⁹³, N M van Schoor⁴⁹, T P van Staa⁹⁴, J Vila⁹⁵, N J Wareham⁹⁶, N C Wright⁹⁷, N Yoshimura⁹⁸, M C Zillikens⁵⁷, M Zwart^{12

99

100

101}, L Vandenput^{3

82}, N C Harvey^{24

25}, M Lorentzon^{3

4}, W D Leslie¹⁰²

Affiliations

¹ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. w.j.Pontefract@sheffield.ac.uk.
² Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. w.j.Pontefract@sheffield.ac.uk.
³ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
⁴ Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
⁵ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
⁶ MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK.
⁷ Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
⁸ Department of Orthopedics, Skåne University Hospital, Malmö, Sweden.
⁹ GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
¹⁰ Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹¹ Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain.
¹² PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain.
¹³ Nordic Bioscience A/S, Herlev, Denmark.
¹⁴ WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁵ Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands.
¹⁶ Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland.
¹⁷ Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland.
¹⁸ Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹⁹ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA.
²⁰ Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.
²¹ St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia.
²² School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia.
²³ INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
²⁴ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
²⁵ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
²⁶ NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK.
²⁷ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
²⁸ San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
²⁹ Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³⁰ Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
³¹ Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
³² Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
³³ Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA.
³⁴ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
³⁵ Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³⁶ Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan.
³⁷ Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
³⁸ Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
³⁹ Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
⁴⁰ Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴¹ Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
⁴² Icelandic Heart Association, Kopavogur, Iceland.
⁴³ University of Iceland, Reykjavik, Iceland.
⁴⁴ MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
⁴⁵ Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland.
⁴⁶ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
⁴⁷ Department of Rheumatology, St Olavs Hospital, Trondheim, Norway.
⁴⁸ Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK.
⁴⁹ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
⁵⁰ Department of Sociology, VU University, Amsterdam, The Netherlands.
⁵¹ Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan.
⁵² Endocrine Clinic, Elisha Hospital, Haifa, Israel.
⁵³ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
⁵⁴ Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
⁵⁵ Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁵⁶ Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore.
⁵⁷ Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵⁸ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵⁹ IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia.
⁶⁰ Barwon Health, Geelong, Victoria, Australia.
⁶¹ Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia.
⁶² Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.
⁶³ Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
⁶⁴ Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
⁶⁵ Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
⁶⁶ Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁷ Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁸ HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
⁶⁹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁷⁰ Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland.
⁷¹ Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷² Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden.
⁷³ Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
⁷⁴ School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
⁷⁵ Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden.
⁷⁶ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁷⁷ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
⁷⁸ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁷⁹ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
⁸⁰ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria.
⁸¹ Center for Biomarker Research in Medicine, Graz, Austria.
⁸² Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸³ Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
⁸⁴ Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
⁸⁵ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
⁸⁶ Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France.
⁸⁷ Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA.
⁸⁸ Janus Rehabilitation, Reykjavik, Iceland.
⁸⁹ Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
⁹⁰ INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
⁹¹ PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
⁹² Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁹³ York Trials Unit, Department of Health Sciences, University of York, York, UK.
⁹⁴ Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.
⁹⁵ Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
⁹⁶ MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
⁹⁷ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹⁸ Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
⁹⁹ Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain.
¹⁰⁰ Department of Medical Sciences, University of Girona, Girona, Spain.
¹⁰¹ GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain.
¹⁰² Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

PMID: 37566158
PMCID: PMC7615305
DOI: 10.1007/s00198-023-06870-z

Meta-Analysis

Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX

J A Kanis et al. Osteoporos Int. 2023 Dec.

. 2023 Dec;34(12):2027-2045.

doi: 10.1007/s00198-023-06870-z. Epub 2023 Aug 11.

Authors

Affiliations

¹ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. w.j.Pontefract@sheffield.ac.uk.
² Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. w.j.Pontefract@sheffield.ac.uk.
³ Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
⁴ Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
⁵ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
⁶ MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK.
⁷ Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
⁸ Department of Orthopedics, Skåne University Hospital, Malmö, Sweden.
⁹ GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
¹⁰ Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹¹ Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain.
¹² PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain.
¹³ Nordic Bioscience A/S, Herlev, Denmark.
¹⁴ WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁵ Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands.
¹⁶ Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland.
¹⁷ Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland.
¹⁸ Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹⁹ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA.
²⁰ Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.
²¹ St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia.
²² School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia.
²³ INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
²⁴ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
²⁵ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
²⁶ NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK.
²⁷ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
²⁸ San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA.
²⁹ Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³⁰ Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
³¹ Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
³² Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
³³ Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA.
³⁴ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
³⁵ Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³⁶ Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan.
³⁷ Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
³⁸ Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
³⁹ Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
⁴⁰ Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴¹ Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
⁴² Icelandic Heart Association, Kopavogur, Iceland.
⁴³ University of Iceland, Reykjavik, Iceland.
⁴⁴ MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
⁴⁵ Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland.
⁴⁶ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
⁴⁷ Department of Rheumatology, St Olavs Hospital, Trondheim, Norway.
⁴⁸ Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK.
⁴⁹ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
⁵⁰ Department of Sociology, VU University, Amsterdam, The Netherlands.
⁵¹ Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan.
⁵² Endocrine Clinic, Elisha Hospital, Haifa, Israel.
⁵³ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
⁵⁴ Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA.
⁵⁵ Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁵⁶ Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore.
⁵⁷ Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵⁸ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵⁹ IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia.
⁶⁰ Barwon Health, Geelong, Victoria, Australia.
⁶¹ Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia.
⁶² Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.
⁶³ Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
⁶⁴ Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
⁶⁵ Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
⁶⁶ Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁷ Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁸ HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
⁶⁹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁷⁰ Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland.
⁷¹ Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷² Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden.
⁷³ Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
⁷⁴ School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
⁷⁵ Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden.
⁷⁶ Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁷⁷ Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
⁷⁸ National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁷⁹ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK.
⁸⁰ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria.
⁸¹ Center for Biomarker Research in Medicine, Graz, Austria.
⁸² Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸³ Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
⁸⁴ Department of Medicine, Oregon Health and Science University, Portland, OR, USA.
⁸⁵ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
⁸⁶ Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France.
⁸⁷ Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA.
⁸⁸ Janus Rehabilitation, Reykjavik, Iceland.
⁸⁹ Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
⁹⁰ INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
⁹¹ PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
⁹² Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.
⁹³ York Trials Unit, Department of Health Sciences, University of York, York, UK.
⁹⁴ Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.
⁹⁵ Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
⁹⁶ MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
⁹⁷ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁹⁸ Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
⁹⁹ Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain.
¹⁰⁰ Department of Medical Sciences, University of Girona, Girona, Spain.
¹⁰¹ GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain.
¹⁰² Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

PMID: 37566158
PMCID: PMC7615305
DOI: 10.1007/s00198-023-06870-z

Abstract

A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX.

Introduction: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD).

Methods: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients.

Results: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination.

Conclusion: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.

Keywords: Hip fracture; Major osteoporotic fracture; Meta-analysis; Osteoporotic fracture; Prior fracture.

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Conflict of interest statement

Conflict of interest

JA Kanis led the team that developed FRAX as director of the WHO Collaborating Centre for Metabolic Bone Diseases. EV McCloskey, WD Leslie, M Lorentzon, NC Harvey, E Liu, L Vandenput and H Johansson are members of the FRAX team. JA Kanis, NC Harvey, and EV McCloskey are members of the advisory body to the National Osteoporosis Guideline Group. JA Kanis reports no additional competing interests.

KE Åkesson has no financial interest related to FRAX; chaired the National SALAR Group for Person-Centered Care Pathway Osteoporosis.

FA Anderson led the team that developed GLOW, while director of the Center for Outcomes Research at the University of Massachusetts Medical School; he has no financial interest in FRAX.

R Azagra has received funding for research from Instituto Carlos III of Spanish Ministry of Health, IDIAP Jordi Gol of Catalan Government and from Scientific Societies SEMFYC and SEIOMM.

CL Bager is employed at Nordic Bioscience and owns stock in Nordic Bioscience. She declares no competing interests in relation to this work.

HA Bischoff-Ferrari has no financial interest in FRAX. For the DO-HEALTH trial cohort, Prof. Bischoff-Ferrari reports independent and investigator-initiated grants from European Commission Framework 7 Research Program, from the University of Zurich, from NESTEC, from Pfizer Consumer Healthcare, from Streuli Pharma, plus non-financial support from DNP. For the study cohort extension, she reports independent and investigator-initiated grants from Pfizer and from Vifor. Further, Prof. Bischoff-Ferrari reports non-financial support from Roche Diagnostics and personal fees from Wild, Sandoz, Pfizer, Vifor, Mylan, Roche, Meda Pharma, outside the submitted work with regard to speaker fees and travel fees.

JR Center has received honoraria for speaking at educational meetings and for advisory boards from Amgen and honoraria for an advisory board from Bayer.

R Chapurlat has no financial interest in FRAX. He has received grant funding from Amgen, UCB, Chugai, MSD, Mylan and Medac. He has received honoraria from Amgen, UCB, Chugai, Galapagos, Biocon, Abbvie, Haoma Medica, Pfizer, Amolyt, MSD, Lilly, BMS, Novartis, Arrow, PKMed, Kyowa-Kirin, and Sanofi.

C Christiansen owns stock in Nordic Bioscience. He declares no competing interests in relation to this work.

C Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda and UCB.

A Diez-Perez reports personal fees from Amgen, Lilly, Theramex and grants from Instituto Carlos III and owns shares of Active Life Scientific, all outside the submitted work.

JA Eisman declares consulting and research support from Actavis, Amgen, Aspen, Lilly, Merck Sharp and Dohme, Novartis, Sanofi-Aventis, Servier and Theramex.

PJM Elders has no financial interest in FRAX. PJM Elders reports support for the SOS study by Stichting Achmea Gezondheidszorg, Achmea and VGZ zorgverzekeraar. Additional support was given by the stichting Artsenlaboratorium en Trombosedienst. Outside the submitted work, she did receive independent investigator driven grants by Zonmw, the Netherlands, de Hartstichting, the Netherlands, the European foundation for the study of Diabetes, Amgen the Netherlands, TEVA, the Netherlands and Takeda, the Netherlands.

Claus-C. Glüer reports honoraria and research support from AgNovos, Amgen, osteolabs and UCB unrelated to this work.

NC Harvey has received consultancy/lecture fees/honoraria/grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Radius Health, Servier, Shire, UCB, Consilient Healthcare and Internis Pharma.

DP Kiel has no financial interest in FRAX but has received support for his work in the Framingham Study over the past 30 years by the National Institutes of Health, Astra Zeneca, Merck, Amgen, and Radius Health.

MA Kotowicz has received funding from the National Health and Medical Research Council (NHMRC) Australia, and the Medical Research Future Fund (MRFF) Australia. He has served on advisory boards for Amgen Australia, Novartic and Eli Lilly – all unrelated to this work and is the Director of the Geelong Bone Densitometry Service.

M Lorentzon has received lecture fees from Amgen, Lilly, Meda, Renapharma and UCB Pharma and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma and Consilient Health, all outside the presented work.

EV McCloskey has received consultancy/lecture fees/grant funding/honoraria from AgNovos, Amgen, AstraZeneca, Consilient Healthcare, Fresenius Kabi, Gilead, GSK, Hologic, Internis, Lilly, Merck, Novartis, Pfizer, Radius Health, Redx Oncology, Roche, Sanofi Aventis, UCB, ViiV, Warner Chilcott and I3 Innovus.

C Ohlsson is listed as a coinventor on two patent applications regarding probiotics in osteoporosis treatment.

ES Orwoll reports consulting fees from Amgen, Biocon, Radius, and Bayer, and research support from Mereo.

JA Pasco has received funding from the National Health and Medical Research Council (NHMRC) Australia, and the Medical Research Future Fund (MRFF) Australia, all unrelated to this work.

KMA Swart is an employee of the PHARMO Institute for Drug Outcomes Research. This independent research institute performs financially supported studies for government and related healthcare authorities and several pharmaceutical companies.

NC Wright sits on the Board of Trustee of the US Bone Health and Osteoporosis Foundation, and has received consulting fees from Radius and ArgenX

MC Zillikens has received honoraria in the past for lectures or advice from Alexion, Amgen, Eli Lilly, Kyowa Kirin, Shire and UCB, unrelated to the current work.

M Zwart has received research funding from national societies (SEMFYC and SEIOMM).

C Beaudart, E Biver, · Bruyère, JA Cauley, CJ Crandall, SR Cummings, JAP da Silva, B Dawson-Huges, AB Dufour, S Ferrari, Y Fujita, S Fujiwara, I Goldshtein, D Goltzman, V Gudnason, J Hall, D Hans, M Hoff, RJ Hollick, M Huisman, M Iki, S Ish-Shalom, H Johansson, G Jones, MK Karlsson, S Khosla, W-P Koh, F Koromani, H Kröger, T Kwok, · Lamy, A Langhammer, B Larijani, WD Leslie, K Lippuner, E Liu, D Mellström, T Merlijn, A Nordström, P Nordström, TW O’Neill, B Obermayer-Pietsch, F Rivadeneira, A-M Schott, EJ Shiroma, K Sigeirsdottir, EM Simonsick, E Sornay-Rendu, R Sund, KMA Swart, P Szulc, J Tamaki, DJ Torgerson, L Vandenput, NM van Schoor, TP van Staa, J Vila, NJ Wareham, N Yoshimura declare no competing interests in relation to this work.

Figures

**Figure 1**
Forest plot showing effect size on hip fracture risk (left panel) and major osteoporotic fracture (right panel) associated with a prior fracture in men and women combined adjusted for age and time since baseline

**Figure 2**
Hazard ratio (HR) and 95% confidence interval of a major osteoporotic fracture (MOF) and hip fracture by age associated with a history of prior fracture in men and women combined. HRs are adjusted for time since baseline and sex.

**Figure 3**
Forest plot showing effect size on osteoporotic fracture risk (left panel) and any clinical fracture (right panel) associated with a prior fracture in men and women combined adjusted for age and time since baseline

See this image and copyright information in PMC

References

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
1. Haentjens P, Johnell O, Kanis JA, Bouillon R, Cooper C, Lamraski G, Vanderschuren D, Kauffman J-M, Boonen S. 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. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Pettersen C, De Laet C, Jonsson B. Fracture risk following an osteoporotic fracture. Osteoporos Int. 2004;15:175–179. - PubMed
1. Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35:375–382. - PubMed
1. Hansen L, Petersen KD, Eriksen SA, Langdahl BL, Eiken PA, Brixen K, Abrahamsen B, Jensen JE, Harslof T, Vestergaard P. Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int. 2015;26:513–9. - PubMed

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Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX

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Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX

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