Osteoporosis International

, Volume 27, Issue 7, pp 2207–2215 | Cite as

Second fractures among older adults in the year following hip, shoulder, or wrist fracture

  • J. P. W. BynumEmail author
  • J.-E. Bell
  • R. V. Cantu
  • Q. Wang
  • C. M. McDonough
  • D. Carmichael
  • T. D. Tosteson
  • A. N. A. Tosteson
Original Article



We report on second fracture occurrence in the year following a hip, shoulder or wrist fracture using insurance claims. Among 273,330 people, 4.3 % had a second fracture; risk did not differ by first fracture type. Estimated adjusted second fracture probabilities may facilitate population-based evaluation of secondary fracture prevention strategies.


The purpose of this study was estimate second fracture risk for the older US population in the year following a hip, shoulder, or wrist fracture.


Observational cohort study of Medicare fee-for-service beneficiaries with an index hip, shoulder, or wrist fragility fracture in 2009. Time-to-event analyses using Cox proportional hazards models to characterize the relationship between index fracture type (hip, shoulder, wrist) and patient factors (age, gender, and comorbidity) on second fracture risk in the year following the index fracture.


Among 273,330 individuals with fracture, 11,885 (4.3 %) sustained a second hip, shoulder or wrist fracture within one year. Hip fracture was most common, regardless of the index fracture type. Comparing adjusted second fracture risks across index fracture types reveals that the magnitude of second fracture risk within each age-comorbidity group is similar regardless of the index fracture. Men and women face similar risks with frequently overlapping confidence intervals, except among women aged 85 years or older who are at greater risk.


Regardless of index fracture type, second fractures are common in the year following hip, shoulder or wrist fracture. Secondary fracture prevention strategies that take a population perspective should be informed by these estimates which take competing mortality risks into account.


Hip fracture Osteoporosis Risk Shoulder fracture Wrist fracture 



This study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (#P60 AR062799).

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interests.

Supplementary material

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ESM 1 (DOCX 120 kb)
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Supplementary Figure 1

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High resolution image (TIF 620 kb)
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Online Supplementary Table 1 (DOCX 31 kb)
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Online Supplementary Table 3 (DOCX 39 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • J. P. W. Bynum
    • 1
    • 2
    Email author
  • J.-E. Bell
    • 3
  • R. V. Cantu
    • 3
  • Q. Wang
    • 1
  • C. M. McDonough
    • 1
    • 4
  • D. Carmichael
    • 1
  • T. D. Tosteson
    • 2
    • 3
  • A. N. A. Tosteson
    • 1
    • 2
    • 3
  1. 1.The Dartmouth Institute for Health Policy and Clinical PracticeGeisel School of Medicine at DartmouthLebanonUSA
  2. 2.Department of MedicineDartmouth-Hitchcock Medical CenterLebanonUSA
  3. 3.Department of Orthopaedic SurgeryDartmouth-Hitchcock Medical CenterLebanonUSA
  4. 4.The Health and Disability Research Institute, Department of Health Policy and ManagementBoston University School of Public HealthBostonUSA

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