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Risk factors for imminent fractures: a substudy of the FRISBEE cohort

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Abstract

Summary

Multiple factors increase the risk of an imminent fracture, including a recent fracture, older age, osteoporosis, comorbidities, and the fracture site. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate treatment.

Introduction

The risk of a recurrent fragility fracture is maximal during the first 2 years following an incident fracture. In this prospective cohort study, we looked at the incidence of recurrent fractures within 2 years after a first incident fracture and we assessed independent clinical risk factors (CRFs) increasing this imminent fracture risk.

Methods

A total of 3560 postmenopausal women recruited from 2007 to 2013 were surveyed yearly for the occurrence of fragility fractures. We identified patients who sustained a fracture during the first 2 years following a first incident fragility fracture. We quantified the risk of a new fracture and assessed independent CRFs, associated with an imminent fracture at various sites.

Results

A recent fracture was a significant CRF for an imminent fracture (OR (95% CI): 3.7 (2.4–5.7) [p < 0.0001]). The incidence of an imminent fracture was higher in subjects above 80 years (p < 0.001). Other CRFs highly predictive in a multivariate analysis were osteoporosis diagnosis (p < 0.01), a central fracture as the index fracture (p < 0.01), and the presence of comorbidities (p < 0.05), with likelihood ratios of 1.9, 1.9, and 2.2, respectively. An imminent fracture was better predicted by a central fracture (p < 0.01) than by a major osteoporotic fracture. The hazard ratio was the highest for a central fracture.

Conclusion

In patients with a recent fracture, older age, osteoporosis, comorbidities, and fracture site were associated with an imminent fracture risk. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate and most appropriate treatment.

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Acknowledgments

The FRISBEE study is supported by CHU Brugmann and IRIS-Recherche.

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Authors and Affiliations

  1. Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium

    L. Iconaru, F. Baleanu, R. Karmali & J. J. Body

  2. Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium

    M. Moreau & M. Paesmans

  3. Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    V. Kinnard, A. Mugisha, M. Surquin & F. Benoit

  4. Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    A. Charles, J. J. Body & P. Bergmann

  5. Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium

    P. Bergmann

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  1. L. Iconaru
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  2. M. Moreau
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  3. F. Baleanu
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Contributions

IL, BJJ, BP, and KV designed the study. MM did the statistical analyses. IL wrote the first draft of the manuscript. IL, BJJ, BP, KV, and BF interpreted the findings. IL, BJJ, BP, MA, SM, BF, KR, and PM revised subsequent versions of the manuscript. All authors read and approved the final version of the paper. IL accepts responsibility for the integrity of the data analyses.

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Correspondence to L. Iconaru.

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J. J. Body and P. Bergmann jointly share the last authorship.

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Iconaru, L., Moreau, M., Baleanu, F. et al. Risk factors for imminent fractures: a substudy of the FRISBEE cohort. Osteoporos Int 32, 1093–1101 (2021). https://doi.org/10.1007/s00198-020-05772-8

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  • DOI: https://doi.org/10.1007/s00198-020-05772-8

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