Re-fracture and correlated risk factors in patients with osteoporotic vertebral fractures

  • Xinling Ma
  • Haiou XiaEmail author
  • Jinhua Wang
  • Xiaoxiao Zhu
  • Fangyan Huang
  • Liuxue Lu
  • Lanyan He
Original Article


Re-fracture risk is higher following osteoporotic fracture. However, there is no accurately reported rate of re-fracture incidence in southwest China. The purpose of this study was to describe the osteoporotic vertebral fracture (OVF) survival for re-fracture state and analyze the risk of re-fracture. This historical cohort study was conducted in four hospitals in southwest China. Patients aged ≥ 50 years (n = 586) with OVF who were supposed to receive anti-osteoporosis drugs after the fracture were included (2012–2017). Telephone follow-up and referring case files were used to estimate the survival for re-fracture and identify the determinants of re-fracture. A total of 555 patients completed the follow-up investigation. Overall, 285 patients experienced a re-fracture, and the longest follow-up investigation time was 72 months. The survival rates for re-fracture at 12 months, 24 months, 36 months, and 48 months were 82.0%, 71.5%, 61.7%, and 34.0%, respectively. The factors correlated with re-fracture hazard were advanced age [hazard ratio (HR) = 1.996], being female (HR = 1.342), smoking (HR = 1.435), history of hypertension (HR = 1.219) and diabetes (HR = 3.271), and persistence of taking anti-osteoporosis drugs after fracture [0–3 months, 4–6 months, 7–12 months, and more than 12 months (HR = 0.703)]. OVF patients with advanced age, who were female, smoked, had fracture with hypertension or diabetes, and who complied poorly with anti-osteoporosis drug treatment presented higher prevalence of re-fracture and low anti-osteoporosis adherence in southwest China. The management of anti-osteoporosis after fracture is necessary in this area.


Osteoporotic vertebral fracture Re-fracture Osteoporosis Anti-osteoporosis 



This research was supported by the Fuxing Nursing Scientific Research Fund of Fudan University (FNF201708) and the National Natural Science Foundation of China (815602390). The research group thanks the patients who participated in this study. In addition, we thank Zhang Xianyan, Huang Chengjing, He Shiyuan, and Lv Shouqiang of Youjiang Medical University for Nationalities, who assisted with the study.

Compliance with ethical standards

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject(s) of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments and/or comparable ethical standards.

Informed consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


  1. 1.
    Oden A, McCloskey EV, Kanis JA, Harvey NC, Johansson H (2015) Burden of high fracture probability worldwide: secular increases 2010–2040. Osteoporos Int 26:2243–2248CrossRefGoogle Scholar
  2. 2.
    Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323CrossRefGoogle Scholar
  3. 3.
    van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:99–102CrossRefGoogle Scholar
  4. 4.
    Gibson-Smith D, Klop C, Elders PJ et al (2014) The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000–2010. Osteoporos Int 25:2555–2563CrossRefGoogle Scholar
  5. 5.
    Raebel MA, Schmittdiel J, Karter AJ, Konieczny JL, Steiner JF (2013) Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases. Med Care 51:S11–S21CrossRefGoogle Scholar
  6. 6.
    Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38:922–928CrossRefGoogle Scholar
  7. 7.
    Qaseem A, Forciea MA, McLean RM, Denberg TD (2017) Treatment of low bone density or osteoporosis to prevent fractures in men and women: a clinical practice guideline update from the American College of Physicians. Ann Intern Med 166:818–839CrossRefGoogle Scholar
  8. 8.
    Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297:387–394CrossRefGoogle Scholar
  9. 9.
    Dinh MM, Berendsen RS, Bein KJ et al (2016) Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why? BMJ Open 6:e10964CrossRefGoogle Scholar
  10. 10.
    Ganda K, Schaffer A, Seibel MJ (2015) Predictors of re-fracture amongst patients managed within a secondary fracture prevention program: a 7-year prospective study. Osteoporos Int 26:543–551CrossRefGoogle Scholar
  11. 11.
    Lih A, Nandapalan H, Kim M et al (2011) Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study. Osteoporos Int 22:849–858CrossRefGoogle Scholar
  12. 12.
    Muheremu A, Peng C, Zhongyan W, Min J, Xinling W (2013) Study on the effect of systematic osteoporosis treatment on the incidence of second fracture and mortality in elderly patients with fracture. J Shanxi Med Univ 44:638–640Google Scholar
  13. 13.
    Tang G (2011) The risk factors of re-fracture assement in eldly osteoporosis fracture patients[D]. Guangzhou Medical School, GuangzhouGoogle Scholar
  14. 14.
    Ye Z, Lu H, Liu P (2017) Association between essential hypertension and bone mineral density: a systematic review and meta-analysis. Oncotarget 8:68916–68927Google Scholar
  15. 15.
    Li C, Zeng Y, Tao L et al (2017) Meta-analysis of hypertension and osteoporotic fracture risk in women and men. Osteoporos Int 28:2309–2318CrossRefGoogle Scholar
  16. 16.
    Thorin MH, Wihlborg A, Akesson K, Gerdhem P (2016) Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years. Osteoporos Int 27:249–255CrossRefGoogle Scholar
  17. 17.
    Kanis JA, Johnell O, Oden A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16:155–162CrossRefGoogle Scholar
  18. 18.
    Tian L, Yang R, Wei L et al (2017) Prevalence of osteoporosis and related lifestyle and metabolic factors of postmenopausal women and elderly men: a cross-sectional study in Gansu province, Northwestern of China. Medicine (Baltimore) 96:e8294CrossRefGoogle Scholar
  19. 19.
    Xiaoyu M, Tong H, Nayin C (2008) Prevalence of smoking and drinking among chronic diseases surveillance population in Guangxi. Pract Prev Med 15(5):1600–1601Google Scholar
  20. 20.
    Xiaoyu M, Nayin C, Hong Y, Yuanyuan W, Ying H, Tong H (2011) Investigation on smoking and passive smoking and smoking cessation among urban and rural residents in Guangxi. Chin J Prev Contr Chron Dis 19(2):206–207Google Scholar
  21. 21.
    Scolaro JA, Schenker ML, Yannascoli S, Baldwin K, Mehta S, Ahn J (2014) Cigarette smoking increases complications following fracture: a systematic review. J Bone Joint Surg Am 96:674–681CrossRefGoogle Scholar
  22. 22.
    Xiaoyun B, Xiufen H, Qinghui Z et al (2016) Characteristics of body composition and the correlation with bone mineral density in middleaged and older Zhuang people in Baise. Chin J Osteoporos 22:183–206Google Scholar
  23. 23.
    Hernlund E, Svedbom A, Ivergard 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 8:136CrossRefGoogle Scholar
  24. 24.
    Kim H, Baek KH, Lee SY et al (2017) Association of circulating dipeptidyl-peptidase 4 levels with osteoporotic fracture in postmenopausal women. Osteoporos Int 28:1099–1108CrossRefGoogle Scholar
  25. 25.
    van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:99–102CrossRefGoogle Scholar
  26. 26.
    Esses SI, McGuire R, Jenkins J et al (2011) The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg 19:176–182CrossRefGoogle Scholar
  27. 27.
    Reyes C, Tebe C, Martinez-Laguna D et al (2017) One and two-year persistence with different anti-osteoporosis medications: a retrospective cohort study. Osteoporos Int 28:2997–3004CrossRefGoogle Scholar
  28. 28.
    Martin-Merino E, Huerta-Alvarez C, Prieto-Alhambra D, Montero-Corominas D (2017) Cessation rate of anti-osteoporosis treatments and risk factors in Spanish primary care settings: a population-based cohort analysis. Arch Osteoporos 12:39CrossRefGoogle Scholar

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Xinling Ma
    • 1
  • Haiou Xia
    • 1
    Email author
  • Jinhua Wang
    • 2
    • 4
  • Xiaoxiao Zhu
    • 1
  • Fangyan Huang
    • 2
  • Liuxue Lu
    • 3
  • Lanyan He
    • 3
  1. 1.School of NursingFudan UniversityShanghaiChina
  2. 2.Youjiang Medical University for NationalitiesBaiseChina
  3. 3.The Affiliated Hospital of Youjiang Medical University for NationalitiesBaiseChina
  4. 4.West China School of Basic Medical Sciences and Forensic MedicineSichuan UniversitySichuanChina

Personalised recommendations