Zoledronic acid treatment was associated with a significantly reduced risk of vertebral fracture among men with osteoporosis. (Funded by Novartis Pharma; ClinicalTrials.gov number, NCT00439647.).

In patients with prior hip fracture (HFx), little is known about time frame and risk factors of second HFx, as well as the ensuing mortality. The aim of the study was to elucidate the incidence of second HFx and subsequent mortality. All 169,145 patients with a first HFx in Denmark during 1977-2001 were followed for up to 25 yr and compared with the background population. Data on fractures, vital status, comorbidity, redeemed prescriptions, and socio-demographic variables were retrieved from national registers. Median follow-up was 3.8 yr, corresponding to 1,041,177 patient-years. A total of 27,834 patients had a second HFx. The cumulative incidence was 9% after 1 yr and 20% after 5 yr, being significantly higher than expected (2% and 12%, respectively; p < 0.05). The RR of second HFx was 2.2 (95% CI: 2.0-2.5) at 1 yr and did not normalize until 15 yr (RR = 1.01, 95% CI: 1.0-1.02). Risk factors for a second HFx were female sex (HR = 1.36, 95% CI: 1.32-1.40), age (HR = 1.68, 95% CI: 1.60-1.76 in patients >85 yr), alcoholism (HR = 1.61, 95% CI: 1.51-1.72), any prior fracture (HR = 1.08, 95%CI :1.04-1.11), and living alone (HR = 1.06, 95% CI: 1.04-1.09). Both sexes had higher mortality at 1 and 5 yr after a second HFx compared with the background population (men-1 yr: 27% versus 9%, p < 0.05; 5 yr: 64% versus 40%, p < 0.05; women-1 yr: 21% versus 10%, p < 0.05; 5 yr: 58% versus 41%, p < 0.05). Patients with HFx are at 2-fold risk of further HFx and the subsequent mortality is highly increased. We propose that programs for secondary prevention should be developed and tested.

Drs Ioannidis and Trikalinos had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs van Meurs and Trikalinos contributed equally to this article.

Objective: To estimate the incidence of nutritional rickets and the incidence and prevalence of hereditary rickets. Design: Population-based retrospective cohort study based on a review of medical records. Methods: Patients aged 0-14.9 years referred to or discharged from hospitals in southern Denmark from 1985 to 2005 with a diagnosis of rickets were identified by register search, and their medical records were retrieved. Patients fulfilling the diagnostic criteria of primary rickets were included. Results: We identified 112 patients with nutritional rickets of whom 74% were immigrants. From 1995 to 2005, the average incidence of nutritional rickets in children aged 0-14.9 and 0-2.9 years was 2.9 and 5.8 per 100 000 per year respectively. Among immigrant children born in Denmark, the average incidence was 60 (0-14.9 years) per 100 000 per year. Ethnic Danish children were only diagnosed in early childhood and the average incidence in the age group 0-2.9 years declined from 5.0 to 2.0 per 100 000 per year during 1985-1994 to 1995-2005. Sixteen cases of hereditary rickets were diagnosed during the study period giving an average incidence of 4.3 per 100 000 (0-0.9 years) per year. The prevalence of hypophosphatemic rickets and vitamin D-dependent rickets type 1 was 4.8 and 0.4 per 100 000 (0-14.9 years) respectively. Conclusions: Nutritional rickets is rare in southern Denmark and largely restricted to immigrants, but the incidence among ethnic Danish children was unexpectedly high. Hereditary rickets is the most common cause of rickets in ethnic Danish children, but nutritional rickets is most frequent among all young children.