Imminent risk of fracture after fracture

Abstract

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.

Úr gögnum Hjartaverndar: Nokkur atriði um faraldsfræði og áhættumat beinbrota á Íslandi

“…[1][2][3] Upplýsingar hafa síðan verið nýttar til að reikna út áhaettu á beinbrotum, sérstaklega meiriháttar beinþynningarbrotum í mismunandi aldurshópum karla og kvenna. Fjórar helstu gerðir meiriháttar beinþynningarbrota eru fjaerendi framhandleggs, naerendi upphandleggs, klínísk hryggsúlubrot og mjaðmarbrot (naerendi laerleggs), og eru þau talin valda um 90% af heildarbyrði allra beinþynningarbrota.…”

“…Þessi tímabundna áhaettu-aukning var meiri meðal aldurshópa eftir sjötugt og svipuð með-al beggja kynja. 3 Meðal sextugra hélst áhaettan hinsvegar óbreytt naestu fimm árin.…”

“…Neðsta línan er áhaettan á fyrsta broti fyrir konur við 75 ára aldur. 3 Tímalengd frá fyrsta meiriháttar beinþynningarbroti (ár).…”

“…These results give a good overall view about the epidemiology of fractures in Iceland in comparison with foreign studies and shows that age standardized incidence of the most important osteoporotic fracture, the hip fracture, reached a maximum around the millennium but has decreased among women until 2008 similar to what has been observed in Sweden and Denmark. Icelandic Heart Association, 2 Janus Rehabilitation, 3 Laekning. 4 The National University Hospital of Iceland, 5 …”

Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts’ consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation

“…Incorporating emerging evidence about osteoporosis and osteoporosis treatment in a new economic guideline is therefore important. Recent evidence includes the development of new osteoporosis treatments (e.g., abaloparatide [21] and romosozumab [22]), the value of sequential therapy [23, 24], effect after treatment discontinuation [25], new data about imminent risk after fractures [26], and the worldwide increase in the use of fracture risk algorithm such as FRAX® [27]. …”