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01-06-2021 | Osteoporosis | Original Article

Risk factors for imminent fractures: a substudy of the FRISBEE cohort

Authors: L. Iconaru, M. Moreau, F. Baleanu, V. Kinnard, A. Charles, A. Mugisha, M. Surquin, F. Benoit, R. Karmali, M. Paesmans, J. J. Body, P. Bergmann

Published in: Osteoporosis International | Issue 6/2021

Abstract

Summary

Multiple factors increase the risk of an imminent fracture, including a recent fracture, older age, osteoporosis, comorbidities, and the fracture site. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate treatment.

Introduction

The risk of a recurrent fragility fracture is maximal during the first 2 years following an incident fracture. In this prospective cohort study, we looked at the incidence of recurrent fractures within 2 years after a first incident fracture and we assessed independent clinical risk factors (CRFs) increasing this imminent fracture risk.

Methods

A total of 3560 postmenopausal women recruited from 2007 to 2013 were surveyed yearly for the occurrence of fragility fractures. We identified patients who sustained a fracture during the first 2 years following a first incident fragility fracture. We quantified the risk of a new fracture and assessed independent CRFs, associated with an imminent fracture at various sites.

Results

A recent fracture was a significant CRF for an imminent fracture (OR (95% CI): 3.7 (2.4–5.7) [p < 0.0001]). The incidence of an imminent fracture was higher in subjects above 80 years (p < 0.001). Other CRFs highly predictive in a multivariate analysis were osteoporosis diagnosis (p < 0.01), a central fracture as the index fracture (p < 0.01), and the presence of comorbidities (p < 0.05), with likelihood ratios of 1.9, 1.9, and 2.2, respectively. An imminent fracture was better predicted by a central fracture (p < 0.01) than by a major osteoporotic fracture. The hazard ratio was the highest for a central fracture.

Conclusion

In patients with a recent fracture, older age, osteoporosis, comorbidities, and fracture site were associated with an imminent fracture risk. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate and most appropriate treatment.

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Roux C, Briot K (2017) Imminent fracture risk. Osteoporos Int 28:1765–1769PubMedCrossRef

Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O, Ortsäter G, Libanati C, Toth E (2019) Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int 30:601–609PubMedPubMedCentralCrossRef

Kanis JA, Harvey NC, Johansson H, Liu E, Vandenput L et al (2020) A decade of FRAX: how has it changed the management of osteoporosis? Aging Clin Exp Res 32:187–196PubMedCrossRef

Eastell R, Rosen CJ, Black DM, Cheung AM (2019) Pharmacological management of osteoporosis in postmenopausal women: an endocrine society* clinical practice guideline. J Clin Endocrinol Metab 104:1595–1622PubMedCrossRef

McCloskey EV, Johansson H, Oden A et al (2012) Denosumab reduces the risk of all osteoporotic fractures in postmenopausal women, particularly in those with moderate to high fracture risk as assessed with FRAX. J Bone Miner Res 27:1480–1486PubMedCrossRef

Liu Z, Li CW, Mao YF, Liu K, Liang BC, Wu LG, Shi XL (2019) Study on zoledronic acid reducing acute bone loss and fracture rates in elderly postoperative patients with intertrochanteric fractures. Orthop Surg 11(3):380–385PubMedPubMedCentralCrossRef

Black DM, Reid IR, Cauley JA, Cosman F, Leung PC, Lakatos P, Lippuner K, Cummings SR, Hue TF, Mukhopadhyay A, Tan M, Aftring RP, Eastell R (2015) The effect of 6 versus 9 years of zoledronic acid treatment in osteoporosis: a randomized second extension to the HORIZON-Pivotal Fracture Trial (PFT). J Bone Miner Res 30(5):934–944PubMedCrossRef

Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P (2018) Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet 391:230–240PubMedCrossRef

Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, Maddox J, Fan M, Meisner PD, Grauer A (2017a) Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med 377:1417–1427PubMedCrossRef

10.

Kanis JA, Johansson H, Oden A et al (2018) Characteristics of recurrent fractures. Osteoporos Int 29:1747–1757PubMedPubMedCentralCrossRef

11.

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 28:2565–2571PubMedPubMedCentralCrossRef

12.

Johnell O, Kanis JA, Oden A et al (2004a) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179PubMedCrossRef

13.

Hansen L, Petersen KD, Eriksen SA, Langdahl BL, Eiken PA, Brixen K, Abrahamsen B, Jensen JEB, Harsløf T, Vestergaard P (2015) Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int 26:513–519PubMedCrossRef

14.

Kanis JA, Johnell O, De Laet C et al (2004) A metaanalysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382PubMedCrossRef

15.

Iconaru L, Moreau M, Kinnard V, Baleanu F, Paesmans M, Karmali R, Body JJ, Bergmann P (2019) Does the prediction accuracy of osteoporotic fractures by BMD and clinical risk factors vary with fracture site? JBMR Plus 3(12):e10238PubMedPubMedCentralCrossRef

16.

Johansson H, Siggeirsdottir K, Harvey NC, Oden A, Gudnason V et al (2017) Imminent risk of fracture after fracture. Osteoporos Int 28:775–780PubMedCrossRef

17.

Pinedo-Villanueva R, Charokopou M, Toth E, Donnelly K, Cooper C, Prieto-Alhambra D, Libanati C, Javaid MK (2019) Imminent fracture risk assessments in the United Kingdom FLS setting: Implications and challenges. Arch Osteoporos 14(1):12PubMedPubMedCentralCrossRef

18.

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(1):26PubMedPubMedCentralCrossRef

19.

Kanis JA, Johansson H, Harvey NC, Gudnason V, Sigurdsson G, Siggeirsdottir K, Lorentzon M, Liu E, Vandenput L, McCloskey EV (2020b) Adjusting conventional FRAX estimates of fracture probability according to the recency of sentinel fractures. Osteoporos Int 31(10):1817–1828PubMedPubMedCentralCrossRef

20.

Borgen TT, Bjørnerem A, Solberg LB, Andreasen C, Brunborg C, Stenbro MB, Hübschle LM, Froholdt A, Figved W, Apalset EM, Gjertsen JE, Basso T, Lund I, Hansen AK, Stutzer JM, Omsland TK, Nordsletten L, Frihagen F, Eriksen EF (2019) Post-fracture risk assessment: target the centrally sited fractures first! A substudy of NoFRACT. J Bone Miner Res 34(11):2036–2044PubMedCrossRef

21.

Kinnard V, Baleanu F, Iconaru L, Moreau M, Paesmans M, Body JJ, Bergmann P (2020) Postfracture risk assessment: target the centrally sited fractures first! A substudy of NoFRACT. J Bone Miner Res 35(4):827–828PubMedCrossRef

22.

Cappelle SI, Ramon I, Dekelver C, Rozenberg S, Baleanu F, Karmali R, Rubinstein M, Tondeur M, Moreau M, Paesmans M, Bergmann P, Body JJ (2017) Distribution of clinical risk factors for fracture in a Brussels cohort of postmenopausal women: the FRISBEE study and comparison with other major cohort studies. Maturitas 106:1–7PubMedCrossRef

23.

Baleanu F, Moreau M, Kinnard V, Iconaru L, Karmali R et al (2020a) What is the validity of self-reported fractures? Bone Rep 1(12):100256CrossRef

24.

Baleanu F, Moreau M, Kinnard V, Iconaru L, Karmali R, Rozenberg S, Rubinstein M, Paesmans M, Bergmann P, Body JJ (2020b) Underevaluation of fractures by self-report: an analysis from the FRISBEE cohort. Arch Osteoporos 15(1):61PubMedCrossRef

25.

Armitage P, Berry G (1994) Statistical methods in medical research, 3rd edn. Blackwell Scientific Publications, Oxford

26.

Toth E, Banefelt J, Åkesson K, Spångeus A, Ortsäter G, Libanati C (2020) History of previous fracture and imminent fracture risk in Swedish women aged 55 to 90 years presenting with a fragility fracture. J Bone Miner Res 35(5):861–868PubMedCrossRef

27.

Kanis JA, Harvey NC, McCloskey E, Bruyère O, Veronese N, Lorentzon M, Cooper C, Rizzoli R, Adib G, al-Daghri N, Campusano C, Chandran M, Dawson-Hughes B, Javaid K, Jiwa F, Johansson H, Lee JK, Liu E, Messina D, Mkinsi O, Pinto D, Prieto-Alhambra D, Saag K, Xia W, Zakraoui L, Reginster JY (2020a) Algorithm for the management of patients at low/middle/high risk of osteoporotic fracture: a global perspective. Osteoporos Int 31:1–12PubMedCrossRef

28.

Crandall CJ, Hovey KM, Cauley JA, Andrews CA, Curtis JR, Wactawski-Wende J, Wright NC, Li W, LeBoff MS (2015) Wrist fracture and risk of subsequent fracture: findings from the Women’s Health Initiative Study. J Bone Miner Res 30(11):2086–2095PubMedCrossRef

29.

Chen W, Simpson JM, March LM, Blyth FM, Bliuc D, Tran T, Nguyen TV, Eisman JA, Center JR (2018) Co-morbidities only account for a small proportion of excess mortality after fracture: a record linkage study of individual fracture types. J Bone Miner Res 33(5):795–802PubMedCrossRef

30.

Johnell O, Kanis JA, Oden A et al (2004b) Mortality after osteoporotic fractures. Osteoporos Int 15(1):38–42PubMedCrossRef

31.

Shauver MJ, Zhong L, Chung KC (2015) Mortality after distal radial fractures in the Medicare population. J Hand Surg Eur 40(8):805–811CrossRef

32.

Hernlund E, Svedbom A, Ivergård M et al (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 8:136PubMedPubMedCentralCrossRef

33.

Iconaru L, Smeys C, Baleanu F, Kinnard V, Moreau M, Cappelle S, Surquin M, Rubinstein M, Rozenberg S, Paesmans M, Karmali R, Bergmann P, Body JJ (2020) Osteoporosis treatment gap in a prospective cohort of volunteer women. Osteoporos Int 31(7):1377–1382PubMedCrossRef

34.

Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, Rodriguez-Portales J, Downs RW Jr, Dequeker J, Favus M, Seeman E, Recker RR, Capizzi T, Santora AC, Lombardi A, Shah RV, Hirsch LJ, Karpf DB (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 333(22):1437–1443PubMedCrossRef

35.

Chesnut CH 3rd, Skag A, Christiansen C et al (2004) Oral ibandronate osteoporosis vertebral fracture trial in North America and Europe (BONE). Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19(8):1241–1249PubMedCrossRef

36.

Harris ST, Watts NB, Genant HK, McKeever C, Hangartner T, Keller M, Chesnut CH 3rd, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282(14):1344–1352PubMedCrossRef

37.

Cummings SR, San Martin J et al (2007) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361(8):756–765CrossRef

38.

Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR, HORIZON Pivotal Fracture Trial (2007a) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822PubMedCrossRef

39.

Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR, HORIZON Pivotal Fracture Trial (2007b) HORIZON Pivotal Fracture Trial. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356(18):1809–1822PubMedCrossRef

40.

Miller PD, Hattersley G, Riis BJ et al (2017) ACTIVE Study Investigators. Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial. JAMA 316(7):722–733CrossRef

41.

Cosman F, Crittenden DB, Adachi JD, Binkley N, Czerwinski E (2016) Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med 375:1532–1543PubMedCrossRef

42.

Body JJ, Marin F, Kendler DL, Zerbini CAF, López-Romero P, Möricke R, Casado E, Fahrleitner-Pammer A, Stepan JJ, Lespessailles E, Minisola S, Geusens P (2020) Efficacy of teriparatide compared with risedronate on FRAX®-defined major osteoporotic fractures: results of the VERO clinical trial. Osteoporos Int 31:1935–1942PubMedPubMedCentralCrossRef

Title: Risk factors for imminent fractures: a substudy of the FRISBEE cohort
Authors: L. Iconaru
M. Moreau
F. Baleanu
V. Kinnard
A. Charles
A. Mugisha
M. Surquin
F. Benoit
R. Karmali
M. Paesmans
J. J. Body
P. Bergmann
Publication date: 01-06-2021
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Osteoporosis International / Issue 6/2021
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05772-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for imminent fractures: a substudy of the FRISBEE cohort

Abstract

Summary

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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