Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective

Hansen, Louise; Petersen, Karin Dam; Eriksen, Stine Aistrup; Langdahl, Bente; Eiken, Patrick W.; Brixen, Kim; Abrahamsen, Bo; Jensen, Jens–Erik Beck; Harsløf, Torben; Vestergaard, Peter

doi:10.1007/s00198-014-2875-2

Cited by 51 publications

(31 citation statements)

References 28 publications

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“…Incidence (per 1000 PYs) of first fracture has previously been reported among the general population for these study populations, and was as follows: hip = 4.9, wrist = 4.8, forearm = 5.9, vertebral = 1.3, humerus = 4.1, and pelvis = 0.7 (Danish Health Registries); hip = 2.23, wrist/forearm = 2.56, clinical spine = 1.98, humerus = 1.55, and pelvis = 0.04 (SIDIAP). The rate of first fracture among all‐incident oral BP users within the Danish Health Registries (55.2/1000 PYs) is comparable with previous work and would appear to be representative of Danish BP users.…”

Section: Discussionmentioning

confidence: 59%

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Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates: A Binational Population-Based Cohort Study

Hawley

Javaid

Rubin

et al. 2015

Journal of Bone and Mineral Research

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Oral bisphosphonates (BPs) are highly effective in preventing fractures and are recommended first-line therapies for patients with osteoporosis. We identified the incidence and predictors of oral BP treatment failure, defined as the incidence of two or more fractures while on treatment (!2 FWOT) among users with high adherence. Fractures were considered from 6 months after treatment initiation and up to 6 months after discontinuation. Data from computerized records and pharmacy invoices were obtained from Sistema d'Informacio per al Desenvolupament de l'Investigacio en Atencio Primaria (SIDIAP; Catalonia, Spain) and Danish Health Registries (Denmark) for all incident users of oral BPs in 2006-2007 and 2000-2001, respectively. Fine and Gray survival models using backwardstepwise selection (p-entry 0.049; p-exit 0.10) and accounting for the competing risk of therapy cessation were used to identify predictors of !2 FWOT among patients having persisted with treatment !6 months with overall medication possession ratio (MPR) !80%. Incidence of !2 FWOT was 2.4 (95% confidence interval [CI], 1.8 to 3.2) and 1.7 (95% CI, 1.2 to 2.2) per 1000 patient-years (PYs) within Catalonia and Denmark, respectively. Older age was predictive of !2 FWOT in both Catalonian and Danish cohorts: subhazard ratio (SHR) ¼ 2.28 (95% CI, 1.11 to 4.68) and SHR ¼ 2.61 (95% CI, 0.98 to 6.95), respectively, for 65 to <80 years; and SHR ¼ 3.19 (95% CI, 1.33 to 7.69) and SHR ¼ 4.88 (95% CI, 1.74 to 13.7), respectively, for !80 years. Further significant predictors of !2 FWOT identified within only one cohort were dementia, SHR ¼ 4.46 (95% CI, 1.02 to 19.4) (SIDIAP); and history of recent or older fracture, SHR ¼ 3.40 (95% CI, 1.50 to 7.68) and SHR ¼ 2.08 (95% CI: 1.04-4.15), respectively (Denmark). Even among highly adherent users of oral BP therapy, a minority sustain multiple fractures while on treatment. Older age was predictive of increased risk within both study populations, as was history of recent/old fracture and dementia within one but not both populations. Additional and/or alternative strategies should be investigated for these patients.

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Section: Discussionmentioning

confidence: 59%

“…Incidence (per 1000 PYs) of first fracture has previously been reported among the general population for these study populations, (27,28) and was as follows: hip ¼ 4.9, wrist ¼ 4. (29) and would appear to be representative of Danish BP users.…”

Section: Journal Of Bone and Mineral Researchmentioning

confidence: 64%

Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates: A Binational Population-Based Cohort Study

Hawley

Javaid

Rubin

et al. 2015

Journal of Bone and Mineral Research

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“…The same relative risks were found in men and women, though the absolute risk was higher in women. This transient phenomenon will be missed in long-term follow-up studies where the pattern of risk with time is not studied [2,[19][20][21]. Several previous studies have found that a recent occurrence of fracture was a greater risk factor for subsequent fracture than a history of earlier fracture, demonstrated for vertebral fracture [6,11], hip, humeral and forearm fractures [3,6] and all fractures combined [12].…”

Section: Discussionmentioning

confidence: 98%

“…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%

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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“…Furthermore, including exposures over the long term with the same weight as recent exposures might dilute the risk associated with these exposures if only the short‐term association is present. This is likely the case for prior fractures where the risk of new fractures and risk of mortality is strongly dependent on the recency of the first fracture …”

Section: Discussionmentioning

confidence: 99%

A New Fracture Risk Assessment Tool (FREM) Based on Public Health Registries

Rubin

Möller

Holmberg

et al. 2018

Journal of Bone and Mineral Research

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Some conditions are already known to be associated with an increased risk of osteoporotic fractures. Other conditions may also be significant indicators of increased risk. The aim of the current study was to identify conditions for inclusion in a fracture prediction model (fracture risk evaluation model [FREM]) for automated case finding of high-risk individuals of hip or major osteoporotic fractures (MOFs). We included the total population of Denmark aged 45+ years (N = 2,495,339). All hospital diagnoses from 1998 to 2012 were used as possible conditions; the primary outcome was MOFs during 2013. Our cohort was split randomly 50/50 into a development and a validation dataset for deriving and validating the predictive model. We applied backward selection on ICD-10 codes (International Classification of Diseases and Related Health Problems, 10th Revision) by logistic regression to develop an age-adjusted and sex-stratified model. The FREM for MOFs included 38 and 43 risk factors for women and men, respectively. Testing FREM for MOFs in the validation cohort showed good accuracy; it produced receiver-operating characteristic (ROC) curves with an area under the ROC curve (AUC) of 0.750 (95% CI, 0.741 to 0.795) and 0.752 (95% CI, 0.743 to 0.761) for women and men, respectively. The FREM for hip fractures included 32 risk factors for both genders and showed an even higher accuracy in the validation cohort as AUCs of 0.874 (95% CI, 0.869 to 0.879) and 0.851 (95% CI, 0.841 to 0.861) for women and men were found, respectively. We have developed and tested a prediction model (FREM) for identifying men and women at high risk of MOFs or hip fractures by using solely existing administrative data. The FREM could be employed either at the point of care integrated into electronic patient record systems to alert physicians or deployed centrally in a national case-finding strategy where patients at high fracture risk could be invited to a focused DXA program. © 2018 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).

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Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective

Abstract: Patients suffering a fracture (and especially a hip fracture) have a high incidence of subsequent fracture. Fractures after the age of 50 may be considered an early warning of increased risk for future fractures in many patients.

Cited by 51 publications

References 28 publications

Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates: A Binational Population-Based Cohort Study

Incidence and Predictors of Multiple Fractures Despite High Adherence to Oral Bisphosphonates: A Binational Population-Based Cohort Study

Imminent risk of fracture after fracture

A New Fracture Risk Assessment Tool (FREM) Based on Public Health Registries

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