A meta-analysis of previous fracture and subsequent fracture risk

Kanis, JA; Johnell, Olof; Laet, Chris De; Johansson, Helena; Odén, Anders; Delmas, Pierre D.; Eisman, John A.; Fujiwara, Saeko; Garnero, Patrick; Kröger, Heikki; McCloskey, Eugène; Mellström, Dan; Melton, L. Joseph; Pols, Huibert A. P.; Reeve, J.; Silman, Alan J.; Tenenhouse, Alan

doi:10.1016/j.bone.2004.03.024

Cited by 1,115 publications

(741 citation statements)

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“…It might be related to differences in the study populations, especially with regard to age and the type of incident fractures (hip versus other fractures) or the methods used. As already reported, (18)(19)(20) and not surprisingly, our study confirms that a history of a fragility fracture is a powerful predictor of future fracture independent of BMD. The multivariable-and BMD-adjusted risk of a major OP fracture was 2.3-to 2.5-fold higher in women who had reported a prior low-trauma fracture after the age of 45 years compared with women without a prior fracture history.…”

Section: Discussionsupporting

confidence: 91%

Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: Sensitivity of the WHO FRAX tool

Trémollières

Pouillès

Drewniak

et al. 2010

Journal of Bone and Mineral Research

179

114

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The aim of this prospective study was (1) to identify significant and independent clinical risk factors (CRFs) for major osteoporotic (OP) fracture among peri-and early postmenopausal women, (2) to assess, in this population, the discriminatory capacity of FRAX and bone mineral density (BMD) for the identification of women at high risk of fracture, and (3) to assess whether adding risk factors to either FRAX or BMD would improve discriminatory capacity. The study population included 2651 peri-and early postmenopausal women [mean age (AE SD): 54 AE 4 years] with a mean follow-up period of 13.4 years (AE1.4 years). At baseline, a large set of CRFs was recorded, and vertebral BMD was measured (Lunar, DPX) in all women. Femoral neck BMD also was measured in 1399 women in addition to spine BMD. Women with current or past OP treatment for more than 3 months at baseline (n ¼ 454) were excluded from the analyses. Over the follow-up period, 415 women sustained a first low-energy fracture, including 145 major OP fractures (108 wrist, 44 spine, 20 proximal humerus, and 13 hip). In Cox multivariate regression models, only 3 CRFs were significant predictors of a major OP fracture independent of BMD and age: a personal history of fracture, three or more pregnancies, and current postmenopausal hormone therapy. In the subsample of women who had a hip BMD measurement and who were not receiving OP therapy (including hormone-replacement therapy) at baseline, mean FRAX value was 3.8% (AE2.4%). The overall discriminative value for fracture, as measured by the area under the Receiver Operating Characteristic (ROC) curve (AUC), was equal to 0.63 [95% confidence interval (CI) 0.56-0.69] and 0.66 (95% CI 0.60-0.73), respectively, for FRAX and hip BMD. Sensitivity of both tools was low (ie, around 50% for 30% of the women classified as the highest risk). Adding parity to the predictive model including FRAX or using a simple risk score based on the best predictive model in our population did not significantly improve the discriminatory capacity over BMD alone. Only a limited number of clinical risk factors were found associated with the risk of major OP fracture in peri-and early postmenopausal women. In this population, the FRAX tool, like other risk scores combining CRFs to either BMD or FRAX, had a poor sensitivity for fracture prediction and did not significantly improve the discriminatory value of hip BMD alone. ß

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Section: Discussionsupporting

confidence: 91%

Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: Sensitivity of the WHO FRAX tool

Trémollières

Pouillès

Drewniak

et al. 2010

Journal of Bone and Mineral Research

179

114

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“…It is well established that fragility fractures increase the risk of a further fracture [1][2][3][4]. In a meta-analysis performed by Klotzbuecher et al [5], the relative risk of having a hip fracture or a vertebral fracture was approximately 2-fold higher for most types of prior fracture.…”

Section: Introductionmentioning

confidence: 98%

“…For example, a large meta-analysis showed that a prior fracture history was a significant risk factor for hip fracture at all ages but was highest at younger ages and decreased progressively with age [3]. Several studies have examined the time course of second fractures by site following an index fracture [6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Imminent risk of fracture after fracture

et al. 2016

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Objectives-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 major osteoporotic fracture (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-5039 individuals sustained one or more MOF, 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 and 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.

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“…M any studies have shown increased fracture risk (1)(2)(3) and mortality (4)(5)(6)(7)(8) after clinical vertebral fracture. Even subjects with no clinical fracture and little pain but with vertebral deformity detected by X-ray showed slightly increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Height loss starting in middle age predicts increased mortality in the elderly

Masunari

Fujiwara

Kasagi

et al. 2011

Journal of Bone and Mineral Research

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The purpose of this study was to determine the mortality risk among Japanese men and women with height loss starting in middle age, taking into account lifestyle and physical factors. A total of 2498 subjects (755 men and 1743 women) aged 47 to 91 years old underwent physical examinations during the period 1994 to 1995. Those individuals were followed for mortality status through 2003. Mortality risk was estimated using an age-stratified Cox proportional hazards model. In addition to sex, adjustment factors such as radiation dose, lifestyle, and physical factors measured at the baseline-including smoking status, alcohol intake, total cholesterol, blood pressure, and diagnosed diseases-were used for analysis of total mortality and mortality from each cause of death. There were a total of 302 all-cause deaths, 46 coronary heart disease and stroke deaths, 58 respiratory deaths including 45 pneumonia deaths, and 132 cancer deaths during the follow-up period. Participants were followed for 20,787 person-years after baseline. Prior history of vertebral deformity and hip fracture were not associated with mortality risk. However, more than 2 cm of height loss starting in middle age showed a significant association with all-cause mortality among the study participants (HR ¼ 1.76, 95% CI 1.31 to 2.38, p ¼ 0.0002), after adjustment was made for sex, attained age, atomic-bomb radiation exposure, and lifestyle and physical factors. Such height loss also was significantly associated with death due to coronary heart disease or stroke (HR ¼ 3.35, 95% CI 1.63 to 6.86, p ¼ 0.0010), as well as respiratory-disease death (HR ¼ 2.52, 95% CI 1.25 to 5.22, p ¼ 0.0130), but not cancer death. Continuous HL also was associated with all-cause mortality and CHD-or stroke-caused mortality. Association between height loss and mortality was still significant, even after excluding persons with vertebral deformity. Height loss of more than 2 cm starting in middle age was an independent risk factor for cardiovascular and respiratory-disease mortality among the elderly, even after adjusting for potential risk factors. ß

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A meta-analysis of previous fracture and subsequent fracture risk

Cited by 1,115 publications

References 53 publications

Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: Sensitivity of the WHO FRAX tool

Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: Sensitivity of the WHO FRAX tool

Imminent risk of fracture after fracture

Height loss starting in middle age predicts increased mortality in the elderly

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