Top

Published in:

Open Access 01-12-2010 | Original Article

Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture

Authors: K. M. B. Huntjens, S. Kosar, T. A. C. M. van Geel, P. P. Geusens, P. Willems, A. Kessels, B. Winkens, P. Brink, S. van Helden

Published in: Osteoporosis International | Issue 12/2010

Abstract

Summary

The absolute 5-year risk of subsequent non-vertebral fractures (NVFs) in 1,921 patients presenting with a NVF was 17.6% and of mortality was 32.3%. These risks were highest within the first year, indicating the need to study which reversible factors can be targeted to immediately minimise subsequent fracture risk and mortality.

Introduction

NVFs are the most frequent clinical fractures in patients presenting at the emergency unit because of a clinical fracture. The aim of the study was to determine the 5-year absolute risk (AR) of subsequent NVF and mortality in patients at the time they present with a NVF.

Methods

Between 1999 and 2001, 1,921 consecutive patients 50+ years from a level 1 trauma centre were included. All NVFs were confirmed on radiograph reports, and mortality was checked in the national obituary database. Available potential risk factors for a subsequent NVF and mortality (age, sex and baseline fracture location: major—hip, pelvis, multiple ribs, proximal tibia/humerus and distal femur; minor—all others) were expressed as hazard ratios (HR) with 95% confidence intervals (CI) using multivariable Cox regression analysis.

Results

The AR for a subsequent NVF was 17.6% and was related to age (HR per decade, 1.44; 95%CI, 1.29–1.60). The AR for mortality was 32.3% and was related to age (HR per decade, 2.59; 95%CI, 2.37–2.84), male sex (HR, 1.74; 95%CI, 1.44–2.10), major fracture at baseline (HR, 5.56; 95%CI, 3.48–8.88; not constant over time) and subsequent fracture (HR, 1.65; 95%CI, 1.33–2.05). The highest risks were found within the first year (NVFs, 6.4%; mortality, 12.2%) and were related to age and, in addition, to baseline fracture location for mortality.

Conclusions

Within 5 years after an initial NVF, nearly one in five patients sustained a subsequent NVF and one in three died. One third of subsequent NVFs and mortality occurred within 1 year, indicating the need to study which reversible factors can be targeted to immediately prevent subsequent fractures and mortality.

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 35:375–382CrossRefPubMed

Klotzbuecher 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 15:721–739CrossRefPubMed

van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:101–104

Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323CrossRefPubMed

Johnell O, Oden A, Caulin F, Kanis JA (2001) Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporos Int 12:207–214CrossRefPubMed

Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. Jama 297:387–394CrossRefPubMed

van Geel AC, Geusens PP, Nagtzaam IF, Schreurs CM, van der Voort DJ, Rinkens PE, Kester AD, Dinant GJ (2006) Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study. BMC Medicine 4:24CrossRefPubMed

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 17:348–354CrossRefPubMed

Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture-a nationwide population-based cohort study of 169, 145 cases during 1977–2001. J Bone Miner Res 24:1299–1307CrossRefPubMed

10.

Chevalley T, Hoffmeyer P, Bonjour JP, Rizzoli R (2002) An osteoporosis clinical pathway for the medical management of patients with low-trauma fracture. Osteoporos Int 13:450–455CrossRefPubMed

11.

Gallacher SJ, Gallagher AP, McQuillian C, Mitchell PJ, Dixon T (2007) The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos Int 18:185–192CrossRefPubMed

12.

van Helden S, Cauberg E, Geusens P, Winkes B, van der Weijden T, Brink P (2007) The fracture and osteoporosis outpatient clinic: an effective strategy for improving implementation of an osteoporosis guideline. J Eval Clin Pract 13:801–805CrossRefPubMed

13.

van Helden S, van Geel AC, Geusens PP, Kessels A, Nieuwenhuijzen Kruseman AC, Brink PR (2008) Bone and fall-related fracture risks in women and men with a recent clinical fracture. J Bone Jt Surg Am 90:241–248CrossRef

14.

Geusens PP, Roux CH, Reid DM, Lems WF, Adami S, Adachi JD, Sambrook PN, Saag KG, Lane NE, Hochberg MC (2008) Drug Insight: choosing a drug treatment strategy for women with osteoporosis—an evidence-based clinical perspective. Nature Clinical Practice 4:240–248CrossRefPubMed

15.

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. Jama 301:513–521CrossRefPubMed

16.

Sebba A (2009) Comparing non-vertebral fracture risk reduction with osteoporosis therapies: looking beneath the surface. Osteoporos Int 20:675–686CrossRefPubMed

17.

Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809CrossRefPubMed

18.

Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882CrossRefPubMed

19.

Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179CrossRefPubMed

20.

Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMed

21.

Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42CrossRefPubMed

22.

Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561CrossRefPubMed

23.

Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefPubMed

24.

Browner WS, Pressman AR, Nevitt MC, Cummings SR (1996) Mortality following fractures in older women. The study of osteoporotic fractures. Arch Intern Med 156:1521–1525CrossRefPubMed

25.

Shortt NL, Robinson CM (2005) Mortality after low-energy fractures in patients aged at least 45 years old. J Orthop Trauma 19:396–400CrossRefPubMed

26.

Piirtola M, Vahlberg T, Lopponen M, Raiha I, Isoaho R, Kivela SL (2008) Fractures as predictors of excess mortality in the aged-a population-based study with a 12-year follow-up. Eur J Epidemiol 23:747–755CrossRefPubMed

27.

Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM (2007) Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol 62:744–751

28.

Dumitrescu B, van Helden S, ten Broeke R, Nieuwenhuijzen-Kruseman A, Wyers C, Udrea G, van der Linden S, Geusens P (2008) Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach. BMC Musculoskeletal Disorders 9:109CrossRefPubMed

29.

Mackey DC, Lui LY, Cawthon PM, Bauer DC, Nevitt MC, Cauley JA, Hillier TA, Lewis CE, Barrett-Connor E, Cummings SR (2007) High-trauma fractures and low bone mineral density in older women and men. Jama 298:2381–2388CrossRefPubMed

Title: Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture
Authors: K. M. B. Huntjens
S. Kosar
T. A. C. M. van Geel
P. P. Geusens
P. Willems
A. Kessels
B. Winkens
P. Brink
S. van Helden
Publication date: 01-12-2010
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 12/2010
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-010-1178-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2010

Circulating osteocalcin concentrations are associated with parameters of liver fat infiltration and increase in parallel to decreased liver enzymes after weight loss

Race/ethnic differences in bone mineral densities in older men

Using clinical risk factors and bone mineral density to determine who among patients undergoing bone densitometry should have vertebral fracture assessment

Birth weight and adult bone mass: a systematic literature review

Detection of vertebral fractures in DXA VFA images using statistical models of appearance and a semi-automatic segmentation

Laser 904 nm action on bone repair in rats with osteoporosis