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Archives of Osteoporosis

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01-12-2022 | Original Article

Incidence of different types of subsequent fractures and related mortality in Taiwan

Authors: Jiun-Liang Chen, Ta-Wei Tai, Che-Yi Chou, Chieh-Ko Ku, Li-Nien Chien, Tsan-Wen Huang, Chao-Hsuin Tang

Published in: Archives of Osteoporosis | Issue 1/2022

Abstract

Summary

Hip fracture is the most common type of fracture to occur within 2 years after an initial fracture. Mortality risk increases when a subsequent fracture occurs. The occurrence of subsequent fracture is significantly higher in patients with hip fractures than others. Prevention of subsequent fracture is of paramount important.

Purpose

Osteoporotic fracture significantly increases risk of subsequent fracture. In this retrospective cohort study, we used the Taiwan National Health Insurance Database (NHIRD) to analyze data on fractures in a group at high risk of osteoporosis. We aimed to distinguish differences in subsequent fracture types and their relationship with mortality.

Methods

We enrolled patients aged ≥ 50 years old who were diagnosed with an initial fracture classified as hip, vertebral, upper end of the humerus, or wrist. Data from 2 years of follow-up were analyzed. Risks of subsequent fracture events and mortality were calculated by Kaplan–Meier estimation and assessed with Cox proportional hazards models.

Results

We included 375,836 patients from the 2011–2015 NHIRD. Patients with initial hip fracture had the highest incidence of subsequent fracture at both 1- and 2-year follow-up (7.0% and 10.9%). Subsequent fractures occurred mainly at the hip. Conversely, other patients had a higher proportion of subsequent vertebral fracture. Patients with subsequent fracture classified as hip, vertebral, and upper end of the humerus had significantly higher cumulative mortality rates than that of patients who had no subsequent fracture, with adjusted hazard ratios of 1.64 (95% CI = 1.57–1.71, p < 0.01), 1.06 (95% CI = 1.00–1.12, p = 0.04), 1.31 (95% CI = 1.17–1.46, p < 0.01), respectively.

Conclusion

Patients who experienced an initial hip fracture are at greatest risk of subsequent fracture, most commonly the hip. Occurrence of subsequent fractures was associated with an increased mortality risk. Thus, there is a need for early intervention following initial hip fractures.

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Choi HJ, Shin CS, Ha YC, Jang S, Jang S, Park C, Yoon HK, Lee SS (2012) Burden of osteoporosis in adults in Korea: a national health insurance database study. J Bone Miner Metab 30:54–58. https://doi.org/10.1007/s00774-011-0280-xCrossRefPubMed

De Martinis M, Sirufo MM, Ginaldi L 2020 Osteoporosis: Current and emerging therapies targeted to immunological checkpoints 27 6356 6372 https://dx.doi.org/10.2174/0929867326666190730113123

Akkawi I, Zmerly H (2018) Osteoporosis: Current concepts. Joints 6:122–127. https://doi.org/10.1055/s-0038-1660790CrossRefPubMedPubMedCentral

Li G, Thabane L, Papaioannou A, Ioannidis G, Levine MA, Adachi JD 2017 An overview of osteoporosis and frailty in the elderly. BMC Musculoskelet Disord 18 46 https://dx.doi.org/10.1186%2Fs12891-017-1403-x

Imai N, Endo N, Shobugawa Y, Oinuma T, Takahashi Y, Suzuki K, Ishikawa Y, Makino T, Suzuki H, Miyasaka D, Sakuma M (2019) Incidence of four major types of osteoporotic fragility fractures among elderly individuals in Sado, Japan, in 2015. J Bone Miner Metab 37:484–490. https://doi.org/10.1007/s00774-018-0937-9CrossRefPubMed

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 301:513–521. https://doi.org/10.1001/jama.2009.50CrossRefPubMed

Chang CY, Tang CH, Chen KC, Huang KC, Huang KC (2016) The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan. Osteoporos Int 27:665–676. https://doi.org/10.1007/s00198-015-3238-3CrossRefPubMed

Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, García-Vadillo A, Mazzucchelli R (2019) Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res 14:203. https://doi.org/10.1186/s13018-019-1226-6CrossRefPubMedPubMedCentral

Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle SG, Grauer A, Curtis JR (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30:79–92. https://doi.org/10.1007/s00198-018-4732-1CrossRefPubMed

10.

Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297:387–394. https://doi.org/10.1001/jama.297.4.387CrossRefPubMed

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 28:2565–2571. https://doi.org/10.1007/s00198-017-4103-3CrossRefPubMedPubMedCentral

12.

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 15:721–739. https://doi.org/10.1359/jbmr.2000.15.4.721CrossRefPubMed

13.

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.2004.03.024CrossRefPubMed

14.

van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629. https://doi.org/10.1007/s001980200084CrossRefPubMed

15.

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 24:1299–1307. https://doi.org/10.1359/jbmr.090207CrossRefPubMed

16.

Jung HS, Nho JH, Ha YC, Jang S, Kim HY, Yoo JI, Park SM, Lee YK 2019 Incidence of osteoporotic refractures following proximal humerus fractures in adults aged 50 years and older in Korea. J Bone Metab 26 105 111 https://dx.doi.org/10.11005%2Fjbm.2019.26.2.105

17.

Yoo JI, Ha YC, Park KS, Kim RB, Seo SH, Koo KH (2019) Incidence and mortality of osteoporotic refractures in Korea according to nationwide claims data. Yonsei Med J 60:969–975. https://doi.org/10.3349/ymj.2019.60.10.969CrossRefPubMedPubMedCentral

18.

Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 4:613–619CrossRef

19.

Bliuc D, Nguyen ND, Nguyen TV, Eisman JA, Center JR (2013) Compound risk of high mortality following osteoporotic fracture and refracture in elderly women and men. J Bone Miner Res 28:2317–2324. https://doi.org/10.1002/jbmr.1968CrossRefPubMed

20.

Ma X, Xia H, Wang J, Zhu X, Huang F, Lu L, He L (2019) Re-fracture and correlated risk factors in patients with osteoporotic vertebral fractures. J Bone Miner Metab 37:722–728. https://doi.org/10.1007/s00774-018-0974-4CrossRefPubMed

21.

Hansen L, Petersen KD, Eriksen SA, Langdahl BL, Eiken PA, Brixen K, Abrahamsen B, Jensen JE, Harsløf T, Vestergaard P (2015) Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int 26:513–519. https://doi.org/10.1007/s00198-014-2875-2CrossRefPubMed

22.

Hsiao PC, Chen TJ, Li CY, Chu CM, Su TP, Wang SH, Pan HH, Wang KY (2015) Risk factors and incidence of repeat osteoporotic fractures among the elderly in Taiwan: a population-based cohort study. Medicine (Baltimore) 94:e532. https://doi.org/10.1097/md.0000000000000532CrossRefPubMed

23.

Sheikh HQ, Hossain FS, Khan S, Usman M, Kapoor H, Aqil A (2019) Short-term risk factors for a second hip fracture in a UK population. Eur J Orthop Surg Traumatol 29:1055–1060. https://doi.org/10.1007/s00590-019-02412-8CrossRefPubMedPubMedCentral

24.

Schnell AD, Curtis JR, Saag KG (2018) Importance of recent fracture as predictor of imminent fracture risk. Curr Osteoporos Rep 16:738–745. https://doi.org/10.1007/s11914-018-0487-zCrossRefPubMed

25.

Brozek W, Reichardt B, Zwerina J, Dimai HP, Klaushofer K, Zwettler E (2016) Antiresorptive therapy and risk of mortality and refracture in osteoporosis-related hip fracture: a nationwide study. Osteoporos Int 27:387–396. https://doi.org/10.1007/s00198-015-3415-4CrossRefPubMed

26.

Chen YC, Lin WC (2017) Poor 1st-year adherence to anti-osteoporotic therapy increases the risk of mortality in patients with magnetic resonance imaging-proven acute osteoporotic vertebral fractures. Patient Prefer Adherence 11:839–843. https://doi.org/10.2147/ppa.s131564CrossRefPubMedPubMedCentral

27.

Chen JS, Chen PM, Lin CY, Chen RF, Lee PY (2016) Beneficial effects of bipolar hemiarthroplasty replacement and fosamax in the retrospective cohort study of refracture and mortality of hip fractured patients. Pak J Pharm Sci 29:1071–1075PubMed

Title: Incidence of different types of subsequent fractures and related mortality in Taiwan
Authors: Jiun-Liang Chen
Ta-Wei Tai
Che-Yi Chou
Chieh-Ko Ku
Li-Nien Chien
Tsan-Wen Huang
Chao-Hsuin Tang
Publication date: 01-12-2022
Publisher: Springer London
Published in: Archives of Osteoporosis / Issue 1/2022
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-022-01098-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Incidence of different types of subsequent fractures and related mortality in Taiwan

Abstract

Summary

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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