medwireNews: Fractures in adulthood are associated with a significantly increased risk for future fractures, regardless of the age at which they occur, show data from a large, population-based study.
The findings suggest that “all non–high-trauma fractures occurring in adulthood, including during early adulthood, should be considered when assessing an individual’s future fracture risk,” write Carrie Ye (University of Alberta, Edmonton, Canada) and co-authors in JAMA Network Open.
This observational, population-based cohort study included 88,696 individuals (mean age 64.6 years, 90.3% women) from the Manitoba Bone Mineral Density Registry who had a mean femoral neck T score of −1.4. Of these, 14.9% had a secondary cause of osteoporosis and 29.1% were receiving anti-osteoporosis treatment.
In all, 21,105 (23.8%) of the participants had sustained at least one prior fracture (excluding those involving the head, neck, hands, and feet) during a mean observation period of 25.1 years before their first dual-energy X-ray absorptiometry measurement. Mean age at the time of the first prior fracture was 57.7 years and ranged from 20.0 to 102.4 years.
Of the total 26,748 prior first fractures, forearm fractures were the most common (31.5%), followed by ankle fractures (16.1%), and vertebral fractures (12.3%).
During a mean 9.0 years of follow-up, 13,239 (14.6%) individuals had one or more incident fractures. These included 12,425 osteoporotic fractures, that is, those occurring at sites other than the ankle, 9440 major osteoporotic fractures (MOFs) to the hip, vertebrae, forearm, or humerus, and 3068 hip fractures.
The researchers report that the risks for incident fractures, osteoporotic fractures, and MOFs, were significantly higher in people with versus without previous fracture across all 10-year age categories and after adjustment for age, sex, BMI, parental hip fracture, smoking status, prolonged glucocorticoid use, rheumatoid arthritis, secondary osteoporosis, high alcohol use, anti-osteoporosis treatment, and femoral neck T score. The only exception was for the risk for incident hip fracture in the youngest age category (20–29 years).
The hazard ratios across the three categories of incident fractures ranged from 1.25 to 3.43, and were generally highest in the youngest age category, but Ye et al note that there was no significant linear trend according to age at first fracture.
The authors point out that studies investigating prior fracture as a risk factor for subsequent fracture typically focus on those occurring after middle to late adulthood. “Consequently, nearly all the major fracture risk calculators, except FRAX, have a lower age cutoff between 40 and 50 years when considering prior fractures,” Ye et al remark.
They say that their findings contrast “with the commonly held notion that only adult fractures occurring at older ages are associated with increased risk of future fractures.”
The investigators add: “Importantly, although the most commonly considered osteoporotic fractures (hip, vertebral, forearm, humerus, and pelvis) were the most frequent prior fractures to occur after 50 years of age, other fractures made up the largest percentage of fractures in the 3 youngest age categories.
“This finding underscores the importance of assessing fractures beyond MOFs, consistent with a meta-analysis of previous studies that found that any prior fracture was associated with a similar increase in fracture risk as prior MOFs.”
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