Imminent risk of fracture after fracture
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The risk of major osteoporotic fracture (MOF) after a first MOF is increased over the whole duration of follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner.
A history of fracture is a strong risk factor for future fractures. The aim of the present study was to determine whether the predictive value of a past MOF for future MOF changed with time.
The study was based on a population-based cohort of 18,872 men and women born between 1907 and 1935. Fractures were documented over 510,265 person-years. An extension of Poisson regression was used to investigate the relationship between the first MOF and the second. All associations were adjusted for age and time since baseline.
Five thousand thirty-nine individuals sustained one or more MOFs, of whom 1919 experienced a second MOF. The risk of a second MOF after a first increased by 4% for each year of age (95% CI 1.02–1.06) and was 41% higher for women than men (95% CI 1.25–1.59). The risk of a second MOF was highest immediately after the first fracture and thereafter decreased with time though remained higher than the population risk throughout follow-up. For example, 1 year after the first MOF, the risk of a second fracture was 2.7 (2.4–3.0) fold higher than the population risk. After 10 years, this risk ratio was 1.4 (1.2–1.6). The effect was more marked with increasing age.
The risk of MOF after a first MOF is increased over the whole follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner, particularly in the elderly.
KeywordsEpidemiology Iceland Osteoporotic fracture Poisson regression model Second fracture
We thank the participants in the Reykjavik Study for their valuable contribution.
Compliance with ethical standards
The study was approved by the National Bioethics Committee and the Data Protection Authority in Iceland. All participants gave informed written consent.
Conflicts of interest
- 13.Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Bjornsson G, Bjornsson OJ, Davidsson D et al (1982) Report abc XXIV. Health survey in the Reykjavik area—women. Stages I-III, 1968–1969, 1971–1972 and 1976–1978. Participants, invitation, response etc. The Icelandic Heart Association, ReykjavíkGoogle Scholar
- 15.Bjornsson OJ, Davidsson D., Olafsson H et al. (1979) Report XVIII. Health survey in the Reykjavik area—men. Stages I–III, 1967–1968, 1970–1971 and 1974–1975. Participants, invitation, response etc. The Icelandic Heart Association, ReykjavíkGoogle Scholar
- 17.Breslow NE, Day NE (1987) Statistical methods in cancer research. IARC Scientific Publications No 32 II:131–135Google Scholar
- 21.Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster J-Y, on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation ( IOF) (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57CrossRefPubMedGoogle Scholar