Top

Osteoporosis International

Published in:

Open Access 01-03-2019 | Osteoporosis | Original Article

Risk of imminent fracture following a previous fracture in a Swedish database study

Authors: J. Banefelt, K.E. Åkesson, A. Spångéus, O. Ljunggren, L. Karlsson, O. Ström, G. Ortsäter, C. Libanati, E. Toth

Published in: Osteoporosis International | Issue 3/2019

Abstract

Summary

This study examined the imminent risk of a future fracture within 1 and 2 years following a first fracture in women aged 50 years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures.

Introduction

This study aims to determine the imminent risk of subsequent fractures within 1 and 2 years following a first fracture and to assess independent factors associated with subsequent fractures.

Methods

Retrospective, observational cohort study of women aged ≥ 50 years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24 months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis.

Results

Two hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12 months was 7.1% (95% confidence interval [CI], 6.9–7.2) and at 24 months was 12.0% (95% CI, 11.8–12.1). The rate of subsequent fractures was highest in the first month (~ 15 fractures per 1000 patient-years) and remained steady between 4 and 24 months (~ 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24 months, sub-distribution hazard ratio [HR], 3.07; p < 0.001 for women 80–89 years [reference 50–59 years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p < 0.001 over 12 months; HR, 2.23; p < 0.001 over 24 months).

Conclusions

Our findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.

Available only for authorised users

Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733. https://doi.org/10.1007/s00198-006-0172-4 CrossRefPubMed

Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the international Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136. https://doi.org/10.1007/s11657-013-0136-1 CrossRefPubMedPubMedCentral

Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmö. Osteoporosis Int 11:669–674. https://doi.org/10.1007/s001980070064 CrossRef

Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA, EU Review Panel of IOF (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137. https://doi.org/10.1007/s11657-013-0137-0 CrossRefPubMedPubMedCentral

Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, Chrischilles EA, Pavlik CE, Wallace RB, Ohsfeldt RL, Jones MP, Rosenthal GE, Wolinsky FD (2009) The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 170:1290–1299. https://doi.org/10.1093/aje/kwp266 CrossRefPubMedPubMedCentral

Leibsen CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriat Soc 50:1644–1650. https://doi.org/10.1046/j.1532-5415.2002.50455.x CrossRef

International Osteoporosis Foundation (2012) Capture the Fracture Report 2012. https://www.iofbonehealth.org/capture-fracture-report-2012. Accessed 27 July 2018

Bliuc D, Alarkawi D, Nguyen TV, Eisman JA, Center JR (2015) Risk of subsequent fractures and mortality in elderly women and men with fragility fractures with and without osteoporotic bone density: the Dubbo osteoporosis epidemiology study. J Bone Miner Res 30:637–646. https://doi.org/10.1002/jbmr.2393 CrossRefPubMed

Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of osteoporotic fractures research group. Arch Intern Med 159:1215–1220. https://doi.org/10.1001/archinte.159.11.1215 CrossRefPubMed

10.

Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, Eriksson S, Wilsgaard T, Jørgensen L, Ahmed LA, Schöttker B, Brenner H, Bellavia A, Wolk A, Kubinova R, Stegeman B, Bobak M, Boffetta P, Trichopoulou A (2017) Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med 281:300–310. https://doi.org/10.1111/joim.12586 CrossRefPubMed

11.

Klop C, van Staa T, Cooper C, Harvey N, de Vries F (2017) The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location, and ethnicity. Osteoporos Int 28:161–168. https://doi.org/10.1007/s00198-016-3787-0 CrossRefPubMed

12.

von Friesendorff M, McGuigan FE, Wizert A, Rogmark C, Holmberg AH, Woolf AD, Akesson K (2016) Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int 27:2945–2953. https://doi.org/10.1007/s00198-016-3616-5 CrossRef

13.

Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381. https://doi.org/10.1007/s00198-014-2794-2 CrossRefPubMedPubMedCentral

14.

Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of osteoporotic fractures research group. J Bone Miner Res 14:821–828. https://doi.org/10.1359/jbmr.1999.14.5.821 CrossRefPubMed

15.

Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E, ASBMR task force on secondary fracture prevention (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27:2039–2046. https://doi.org/10.1002/jbmr.1698 CrossRefPubMed

16.

Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936. https://doi.org/10.1016/S0140-6736(02)08761-5 CrossRefPubMed

17.

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382. https://doi.org/10.1016/j.bone.2004.03.024 CrossRefPubMed

18.

Kloetzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739. https://doi.org/10.1359/jbmr.2000.15.4.721 CrossRef

19.

Roux C, Briot K (2017) Imminent fracture risk. Osteoporos Int 28:1765–1769. https://doi.org/10.1007/s00198-017-3976-5 CrossRefPubMed

20.

Van Geel TACM, Huntjens KM, van den Bergh JP, Dinant GJ, Geusens PP (2010) Timing of subsequent fractures after an initial fracture. Curr Osteoporos Rep 8:118–122. https://doi.org/10.1007/s11914-010-0023-2 CrossRefPubMedPubMedCentral

21.

Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, Sigurdsson G, Kanis JA (2017) Imminent risk of fracture after fracture. Osteoporos Int 28:775–780. https://doi.org/10.1007/s00198-016-3868-0 CrossRefPubMed

22.

McLellan AR, Reid DM, Forbes K, Reid R, Campbell C, Gregori A, Raby N, Simpson A (2004) Effectiveness of strategies for the secondary prevention of osteoporotic fractures in Scotland. http://www.healthcareimprovementscotland.org/previous_resources/audit_report/osteoporotic_fractures_audit.aspx. Accessed 27 July 2018

23.

Bonafede M, Shi N, Barron R, Li X, Crittenden DB, Chandler D (2016) Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data. Arch Osteoporos 11:26. https://doi.org/10.1007/s11657-016-0280-5 CrossRefPubMedPubMedCentral

24.

Kanis JA, Cooper C, Rizzoli R, Abrahamsen B, Al-Daghri NM, Brandi ML, Cannata-Andia J, Cortet B, Dimai HP, Ferrari S, Hadji P, Harvey NC, Kraenzlin M, Kurth A, McCloskey E, Minisola S, Thomas T, Reginster JY, European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) (2017) Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int 28:2023–2034. https://doi.org/10.1007/s00198-017-4009-0 CrossRefPubMedPubMedCentral

25.

Van Geel TACM, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:99–102. https://doi.org/10.1136/ard.2008.092775 CrossRefPubMed

26.

Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, Curtis JR (2016) High risk of second fracture within 1, 2, 5 years after prior fracture among women 65 years or older. J Bone Miner Res 31(Suppl 1):S93 Abstract FR02033

27.

Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42. https://doi.org/10.1007/s00198-003-1490-4 CrossRefPubMed

28.

Weycker D, Edelsberg J, Barron R, Atwood M, Oster G, Crittenden DB, Grauer A (2017) Predictors of near-term fracture in osteoporotic women aged ≥65 years, based on data from the study of osteoporotic fractures. Osteoporos Int 28:2565–2571. https://doi.org/10.1007/s00198-017-4103-3 CrossRefPubMedPubMedCentral

29.

University of Sheffield. FRAX^®: fracture risk assessment tool. https://www.sheffield.ac.uk/FRAX/tool.jsp. Accessed 27 July 2018

30.

GARVAN Institute. Fracture risk calculator. https://www.garvan.org.au/promotions/bone-fracture-risk/calculator/. Accessed 27 July 2018

31.

QFracture. QFracture^®-2016 risk calculator. http://www.qfracture.org/. Accessed 27 July 2018

32.

Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, Mccloskey EV, Advisory Board of the National Osteoporosis Guideline Group (2016) A systematic review of intervention thresholds based on FRAX: a report prepared for the National Osteoporosis Guideline Group and the international Osteoporosis Foundation. Arch Osteoporos 11:25. https://doi.org/10.1007/s11657-016-0278-z CrossRefPubMedPubMedCentral

33.

Leslie WD, Majumdar SR, Morin SN, Lix LM, Johansson H, Oden A, McCloskey EV, Kanis JA (2017) FRAX for fracture prediction shorter and longer than 10 years: the Manitoba BMD registry. Osteoporos Int 28:2557–2564. https://doi.org/10.1007/s00198-017-4091-3 CrossRefPubMed

34.

Feldstein A, Elmer PJ, Orwoll E, Herson M, Hillier T (2003) Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med 163:2165–2172. https://doi.org/10.1001/archinte.163.18.2165.CrossRefPubMed

35.

Siris ES, Adler R, Bilezikian J, Bolognese M, Dawson-Hughes B, Favus MJ, Harris ST, Jan de Beur SM, Khosla S, Lane NE, Lindsay R, Nana AD, Orwoll ES, Saag K, Silverman S, Watts NB (2014) The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 25:1439–1443. https://doi.org/10.1007/s00198-014-2655-z CrossRefPubMedPubMedCentral

36.

Klein JP, Rizzo JD, Zhang MJ, Keiding N (2001) Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part I: unadjusted analysis. Bone Marrow Transplant 28:909–915CrossRefPubMed

37.

Andersen PK, Geskus RB, de Witte T, Putter H (2012) Competing risks in epidemiology: possibilities and pitfalls. Int J Epidemiol 41:861–870CrossRefPubMedPubMedCentral

38.

Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509. https://doi.org/10.1080/01621459.1999.10474144 CrossRef

39.

Socialstyrelsen. Indikatorer för god läkemedelsterapi hos äldre. https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/18085/2010-6-29.pdf. Accessed 21 November 2018

40.

Apoteket. ApoDos—simple and safe. https://www.apoteket.se/vard-foretag/apodos/. Accessed 27 July 2018

41.

Landfeldt E, Ström O, Robbins S, Borgström F (2012) Adherence to treatment of primary osteoporosis and its association to fractures—the Swedish adherence register analysis (SARA). Osteoporos Int 23:433–443CrossRefPubMed

42.

von Friesendorff M, Besjakov J, Akesson K (2008) Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res 23:1832–1841. https://doi.org/10.1359/jbmr.080606 CrossRef

43.

Ahmed LA, Center JR, Bjørnerem A, Bluic D, Joakimsen RM, Jørgensen L, Meyer HE, Nguyen ND, Nguyen TV, Omsland TK, Størmer J, Tell GS, van Geel TA, Eisman JA, Emaus N (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromsø study. J Bone Miner Res 28:2214–2221. https://doi.org/10.1002/jbmr.1952 CrossRefPubMed

44.

Van Helden S, Cals J, Kessels F, Brink P, Dinant GJ, Geusens P (2006) Risk of new clinical fractures within 2 years following a fracture. Osteoporos Int 17:348–354. https://doi.org/10.1007/s00198-005-2026-x CrossRefPubMed

45.

Yusuf A, Hu Y, Chandler D, Crittenden B, Barron R (2016) Characteristics of patients at high one-year fracture risk. J Bone Miner Res 31(Suppl 1):S363 Abstract MO0223

46.

Yusuf A, Hu Y, Chandler D, Crittenden B, Barron R (2016) Predictors of imminent fracture risk in Medicare-enrolled men and women. J Bone Miner Res 31(Suppl 1):S246 Abstract SU0227

47.

Vu T, Davie G, Barson D, Day L, Finch CF (2013) Accuracy of evidence-based criteria for identifying an incident hip fracture in the absence of the date of injury: a retrospective database study. BMJ Open 3. https://doi.org/10.1136/bmjopen-2013-003222

48.

Rosengren BE, Ahlborg HG, Mellström D, Nilsson JÅ, Björk J, Karlsson MK (2012) Secular trends in Swedish hip fractures 1987–2002: birth cohort and period effects. Epidemiology 23:623–630CrossRefPubMed

49.

Yusuf AA, Hu Y, Chandler D, Crittenden B, Barron R (2016) Characteristics of patients at high one-year fracture risk ASBMR Annual Meeting: SU0227

Title: Risk of imminent fracture following a previous fracture in a Swedish database study
Authors: J. Banefelt
K.E. Åkesson
A. Spångéus
O. Ljunggren
L. Karlsson
O. Ström
G. Ortsäter
C. Libanati
E. Toth
Publication date: 01-03-2019
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Osteoporosis International / Issue 3/2019
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-019-04852-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk of imminent fracture following a previous fracture in a Swedish database study

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

Disrupted radial and tibial microarchitecture in patients with monoclonal gammopathy of undetermined significance

Administrative healthcare data applied to fracture risk assessment

Correction to: Lower grip strength and dynamic body balance in women with distal radial fractures

The first biosimilar approved for the treatment of osteoporosis: results of a comparative pharmacokinetic/pharmacodynamic study

Multiple vitamin deficiencies additively increase the risk of incident fractures in Japanese postmenopausal women

A novel FAM20C mutation causing hypophosphatemic osteomalacia with osteosclerosis (mild Raine syndrome) in an elderly man with spontaneous osteonecrosis of the knee