Risk of subsequent fracture after prior fracture among older women

Abstract

SummaryAmong 377,561 female Medicare beneficiaries who sustained a fracture, 10% had another fracture within 1 year, 18% within 2 years, and 31% within 5 years. Timely management to reduce risk of subsequent fracture is warranted following all nontraumatic fractures, including nonhip nonvertebral fractures, in older women.IntroductionPrior fracture is a strong predictor of subsequent fracture; however, postfracture treatment rates are low. Quantifying imminent (12–24 month) risk of subsequent fracture in older women may clarify the need for early postfracture management.MethodsThis retrospective cohort study used Medicare administrative claims data. Women ≥ 65 years who sustained a clinical fracture (clinical vertebral and nonvertebral fracture; index date) and were continuously enrolled for 1-year pre-index and ≥ 1-year (≥ 2 or ≥ 5 years for outcomes at those time points) post-index were included. Cumulative incidence of subsequent fracture was calculated from 30 days post-index to 1, 2, and 5 years post-index. For appendicular fractures, only those requiring hospitalization or surgical repair were counted. Death was considered a competing risk.ResultsAmong 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5 years post-index, respectively. Among women age 65–74 years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women ≥ 75 years regardless of initial fracture site (except ankle and tibia/fibula), 7–14% fractured again within 1 year depending on initial fracture site; risk rose to 15–26% within 2 years and 28–42% within 5 years. Risk of subsequent hip fracture exceeded 3% within 5 years in all women studied, except those < 75 years with an initial tibia/fibula or ankle fracture.ConclusionsWe observed a high and early risk of subsequent fracture following a broad array of initial fractures. Timely management with consideration of pharmacotherapy is warranted in older women following all fracture types evaluated.Electronic supplementary materialThe online version of this article (10.1007/s00198-018-4732-1) contains supplementary material, which is available to authorized users.

History of Previous Fracture and Imminent Fracture Risk in Swedish Women Aged 55 to 90 Years Presenting With a Fragility Fracture

“…The increased risk of suffering a subsequent fracture is highest within the 2 years following the first fragility fracture, then declines . During this period, up to 25% of fracture patients will experience a subsequent fracture depending on the type of previous fracture, with vertebral fractures increasing risk the most . The marked elevation in risk seen in the 24 months following a fragility fracture as compared to lifetime risk is increasingly recognized and termed “imminent risk.”…”

Osteoporosis in the age of COVID-19

“…One in 3 men and one in 5 women will experience an osteoporotic fracture in their lifetime [6]. The risk of re-fracture is greatest in the months following the first fracture, and the timely assessment and rapid treatment of subjects with fracture to prevent further fracture is an essential, established model [7].…”

Antidiabetic and antiosteoporotic pharmacotherapies for prevention and treatment of type 2 diabetes-induced bone disease: protocol for two network meta-analyses

“…There are several potential factors for increased bone resorption and increased fracture incidences apart from T2DM, such as gender, postmenopausal status and age 54. Previous fractures at baseline are also associated with a higher risk of subsequent fractures 55 56. Variations in these characteristics between studies can result in significant heterogeneity and inconsistency.…”