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Rib fractures predict incident limb fractures: results from the European prospective osteoporosis study

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Abstract

Population studies suggest that rib fractures are associated with a reduction in bone mass. While much is known about the predictive risk of hip, spine and distal forearm fracture on the risk of future fracture, little is known about the impact of rib fracture. The aim of this study was to determine whether a recalled history of rib fracture was associated with an increased risk of future limb fracture. Men and women aged 50 years and over were recruited from population registers in 31 European centres for participation in a screening survey of osteoporosis (European Prospective Osteoporosis Study). Subjects were invited to complete an interviewer-administered questionnaire that included questions about previous fractures including rib fracture, the age of their first fracture and also the level of trauma. Lateral spine radiographs were performed and the presence of vertebral deformity was determined morphometrically. Following the baseline survey, subjects were followed prospectively by annual postal questionnaire to determine the occurrence of clinical fractures. The subjects included 6,344 men, with a mean age of 64.2 years, and 6,788 women, with a mean age of 63.6 years, who were followed for a median of 3 years (range 0.4–5.9 years), of whom 135 men (2.3%) and 101 women (1.6%) reported a previous low trauma rib fracture. In total, 138 men and 391 women sustained a limb fracture during follow-up. In women, after age adjustment, those with a recalled history of low trauma rib fracture had an increased risk of sustaining ‘any’ limb fracture [relative hazard (RH) =2.3; 95% CI 1.3, 4.0]. When stratified by fracture type the predictive risk was more marked for hip (RH=7.7; 95% CI 2.3, 25.9) and humerus fracture (RH=4.5; 95% CI 1.4, 14.6) than other sites (RH=1.6; 95% CI 0.6, 4.3). Additional adjustment for prevalent vertebral deformity and previous (non-rib) low trauma fractures at other sites slightly reduced the strength of the association between rib fracture and subsequent limb fracture. In men, after age adjustment, there was a small though non-significant association between recalled history of rib fracture and future limb fracture. Our data highlight the importance of rib fracture as a marker of bone fragility in women.

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Acknowledgements

The study was financially supported by a European Union Concerted Action Grant under Biomed-1 (BMH1CT920182), and also EU grants C1PDCT925102, ERBC1PDCT 930105 and 940229. The central coordination was also supported by the UK Arthritis Research Campaign, the Medical Research Council (G9321536) and the European Foundation for Osteoporosis and Bone Disease. The EU’s PECO program linked to BIOMED 1 funded in part the participation of the Budapest, Warsaw, Prague, Piestany, Szczecin and Moscow centers. Data collection from Croatia was supported by a grant from the Wellcome Trust. The central X-ray evaluation was generously sponsored by the Bundesministerium fuer Forschung and Technologie, Germany. Individual centers acknowledge the receipt of locally acquired support for their data collection. Dr. Abbas Ismail was a Wellcome Trust Clinical Research Fellow. We would like to thank the following individuals: Rita Smith, Aberdeen, UK; Uday Bhonsle, Anna Martin, Judith Walton, Bridget Wardley-Smith, Cambridge and Harrow, UK; Mrs. Joanna Parsons, Truro, UK; J. Bernardino Diaz Lopez, Ana Rodriguez Rebollar, Oviedo, Spain. We would like also to thank the individuals who took part in the study and the many individuals who helped access our population samples.

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Authors and Affiliations

  1. Department of Rheumatology, Stepping Hill Hospital, Stockport, UK

    A. A. Ismail

  2. ARC Epidemiology Unit, University of Manchester, Manchester, UK

    A. J. Silman & T. W. O’Neill

  3. University Department of Medicine, Strangeways Research Laboratory, Worts Causeway, Cambridge, UK

    J. Reeve & S. Kaptoge

Authors
  1. A. A. Ismail
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  2. A. J. Silman
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  3. J. Reeve
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  4. S. Kaptoge
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  5. T. W. O’Neill
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Corresponding author

Correspondence to A. A. Ismail.

Additional information

This study was carried out in conjunction with the EPOS Study Group (see Appendix).

Appendix

Appendix

Members of the EPOS Study Group: Project Coordinators: J. Reeve and A.J. Silman, Cambridge and Manchester, U.K. Austria (Graz) K. Weber; Belgium (Leuven) J. Dequeker; Croatia (Zagreb) I. Jajic; Czech Republic (Prague) J. Stepan; Slovakia (Piestany) P. Masaryk; France (Montceau-Les-Mines) P.D. Delmas, F. Marchand; Germany (Berlin, Steglitz) D. Felsenberg, (Berlin, Potsdam) D. Banzer, (Berlin, Charite) W. Reisinger, (Bochum) J. Janott, (Erfurt) G. Kragl, (Heidelberg) C. Scheidt-Nave, (Jena) B. Felsch, (Lubeck) H. Raspe, C. Matthis; Greece (Athens) G. Lyritis; Hungary (Budapest) G. Poor; Italy (Siena) C. Gennari; The Netherlands (Rotterdam) H.A.P. Pols; Norway (Oslo) J.A. Falch; Poland (Szczecin) T. Miazgowski; (Warsaw) K. Hoszowski, R. Lorenc; Portugal (Azores) J. Bruges Armas, (Oporto) A. Lopez Vaz; Russia (Moscow) L.I. Benevolenskaya; Spain (Madrid) A. Rapado, (Oviedo) J.B. Cannata, M. Naves; Sweden (Malmö) O. Johnell; Turkey (Istanbul) G. Dilsen; United Kingdom (Aberdeen) D.M. Reid, (Bath) A.K. Bhalla, (Cambridge) C.Todd, (Harrow) J. Reeve, (Sheffield) J.A. Kanis, (Southhampton) C. Cooper, (Truro) A..D.Woolf.

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Ismail, A.A., Silman, A.J., Reeve, J. et al. Rib fractures predict incident limb fractures: results from the European prospective osteoporosis study. Osteoporos Int 17, 41–45 (2006). https://doi.org/10.1007/s00198-005-1887-3

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  • DOI: https://doi.org/10.1007/s00198-005-1887-3

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