September 2010, Volume 8, Issue 3, pp 118-122,
Open Access This content is freely available online to anyone, anywhere at any time.
Date: 18 Jun 2010
Timing of Subsequent Fractures after an Initial Fracture
A prior fracture is a well-documented risk factor for a subsequent fracture and it doubles the risk of subsequent fractures. Few studies have investigated the time that elapses between the initial and subsequent fracture. These studies show that the subsequent fracture risk is not constant, but fluctuates over time. The risk of subsequent vertebral, hip, and nonvertebral non-hip fractures is highest immediately after initial hip, clinical, and radiographic vertebral fractures and nonvertebral fractures and declines afterward, regardless of gender, age, and initial fracture location. These studies indicate the need for early action after an initial fracture with medical interventions that have an effect within a short term to reduce the preventable risks of subsequent fractures.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
World Health Organization: W.H.O. Prevention and Management of Osteoporosis. Report of a WHO Scientific Group. WHO Technical Report Series 2003; No 921. Geneva, Switzerland: World Health Organization; 2003.
World Health Organization: WHO Scientific Group on the assessment of osteoporosis at primary health care level. Summary Meeting Report, Brussels, Belgium, 5–7 May 2004. Available at www.who.int/chp/topics/Osteoporosis.pdf. Accessed May 2010.
•• Center JR, Bliuc D, Nguyen TV, Eisman JA: Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 2007, 297:387–394. This study examined the subsequent risk of all fracture types, except fingers and toes, after an initial low-energy trauma fracture in men and women 60 years of age and over taking into account the time relation between fractures. The risk of subsequent fracture was highest immediately after the initial fracture, but was not higher than the risk for individuals without a fracture 10 years after the initial fracture (41% of the subsequent fractures occurred within 2 years).CrossRefPubMed
•• van Geel TA, van Helden S, Geusens PP, et al.: Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 2009, 68:99–102. The results of this study extend the observations of Center et al. [4••] to all clinical vertebral and nonvertebral fractures, in women from menopause onward, and for both low- and high-energy trauma fractures. The initial fracture type was not a predictor for subsequent fractures. The subsequent fracture risk remained higher, compared with initial fracture risk, for 15 years after the initial fracture (23% of the subsequent fractures occurred within 1 year).CrossRefPubMed
Friesendorff von M, Besjakov J, Akesson K: Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J Bone Miner Res 2008, 23:1832–1841.CrossRef
• Berry SD, Samelson EJ, Ngo L, et al.: Subsequent fracture in nursing home residents with a hip fracture: a competing risks approach. J Am Geriatr Soc 2008, 56:1887–1892. In long-term care residents with a surgically repaired hip fracture, 21% sustained a subsequent fracture: 6% of residents experienced a subsequent fracture within 6 months, 12% within 1 year, and 21% within 5 years.CrossRefPubMed
•• Ryg J, Rejnmark L, Overgaard S, et al.: 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 2009, 24:1299–1307. Approximately 170,000 patients with an initial hip fracture were included in this 25-year follow-up study. The cumulative incidence showed that 9% of the subsequent hip fractures were suffered within 1 year and 20% within 5 years. The risk for a subsequent fracture remained significantly higher than the risk for individuals without a fracture for 15 years after the initial fracture.CrossRefPubMed
Giangregorio L, Leslie W: Time since prior fracture is a risk modifier for ten year osteoporotic fractures. J Bone Miner Res 2010 Jan 29 [Epub ahead of print].
- Timing of Subsequent Fractures after an Initial Fracture
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- Available under Open Access This content is freely available online to anyone, anywhere at any time.
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- 1. Department of General Practice, Maastricht University/Caphri, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- 2. Department of General Surgery and Trauma Surgery, Maastricht University Medical Centre/Caphri, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- 3. Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
- 4. Department of Internal Medicine, Maastricht University Medical Centre/Nutrim, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- 5. Subdivision Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre/Caphri, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands