Original Article

Osteoporosis International

, Volume 19, Issue 5, pp 607-613

First online:

Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA)

  • E. Barrett-ConnorAffiliated withDepartment of Family and Preventive Medicine, University of California, San Diego, Stein Clinical Research Building, Room 349 Email author 
  • , S. G. SajjanAffiliated withOutcomes Research & Management, Merck & Co., Inc.
  • , E. S. SirisAffiliated withColumbia University College of Physicians and Surgeons
  • , P. D. MillerAffiliated withColorado Center for Bone Research
  • , Y.-T. ChenAffiliated withOutcomes Research & Management, Merck & Co., Inc.
  • , L. E. MarksonAffiliated withOutcomes Research & Management, Merck & Co., Inc.

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The short-term association between wrist-fracture history and future fracture has not been simultaneously compared between younger and older postmenopausal women. This 3-year follow-up study of 158,940 women showed a similar future fracture risk in younger and older women with wrist-fracture history.


We examined the association between prior wrist fracture and future osteoporosis-related fractures within 3 years in younger and older postmenopausal women.


In the National Osteoporosis Risk Assessment (NORA) study, 158,940 postmenopausal women, aged 50-98 (median 63) years, provided information on fracture history since age 45, and responded to follow-up surveys 1 or 3 years later when new fractures were queried. Cox regression models were used to obtain relative risk (RR) and 95% confidence interval (CI) estimates.


Of the 158,940 participants, 8,665 reported a history of wrist fracture at baseline; 4,316 women reported at least one new fracture within three years. The RR for any subsequent clinical fracture, adjusted for covariates and baseline BMD T-score, was 2.4 (2.0, 2.9) for younger and 2.1 (1.9, 2.3) for older women. A prior wrist fracture increased the risk of a future wrist fracture about 3-fold and doubled the risk of any osteoporotic fracture.


Prior wrist fracture strongly predicts three-year risk of any future osteoporotic fracture for older and younger postmenopausal women, independent of baseline BMD and common osteoporosis risk factors. More consideration should be given to evaluating and managing osteoporosis in younger and older women with a history of wrist fracture, independent of their BMD.


Bone mineral density Osteoporosis Osteoporotic fracture Postmenopausal women Wrist fracture