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The effect on subsequent fracture risk of age, sex, and prior fracture site by recency of prior fracture

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Abstract

Summary

The risk of a recurrent fragility fracture varies by age and sex, as by site and recency of sentinel fracture.

Introduction

The recency of prior fractures affects subsequent fracture risk. Variable recency may obscure other factors that affect subsequent fracture risk. The aim of this study was to quantify the effect of a sentinel fracture by site, age, and sex where the recency was held constant.

Methods

The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Fracture incidence was compared to that of the general population determined at fixed times after a sentinel fracture (humeral, clinical vertebral, forearm, hip, and minor fractures). Outcome fractures comprised a major osteoporotic fracture and hip fracture.

Results

Sentinel osteoporotic fractures were identified in 9504 men and women. Of these, 3616 individuals sustained a major osteoporotic fracture as the first subsequent fracture, of whom 1799 sustained a hip fracture. Hazard ratios for prior fracture were consistently higher in men than in women and decreased progressively with age. Hazard ratios varied according to the site of sentinel fracture with higher ratios for hip and vertebral fracture than for humerus, forearm, or minor osteoporotic fracture.

Conclusion

The risk of a recurrent fragility fracture varies by age, sex, and site of sentinel fracture when recency is held constant.

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Acknowledgments

We thank the participants in the Reykjavik Study for their valuable contribution.

Author information

Authors and Affiliations

  1. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

    J. A. Kanis, H. Johansson, M. Lorentzon, E. Liu & L. Vandenput

  2. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

    J. A. Kanis, H. Johansson & E. V. McCloskey

  3. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    N. C. Harvey

  4. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    N. C. Harvey

  5. Icelandic Heart Association Research Institute, Kopavogur, Iceland

    V. Gudnason, G. Sigurdsson & K. Siggeirsdottir

  6. University of Iceland, Reykjavik, Iceland

    V. Gudnason

  7. Geriatric Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

    M. Lorentzon

  8. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    L. Vandenput

  9. Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK

    E. V. McCloskey

Authors
  1. J. A. Kanis
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  2. H. Johansson
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  3. N. C. Harvey
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  4. V. Gudnason
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  5. G. Sigurdsson
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  6. K. Siggeirsdottir
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  7. M. Lorentzon
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  8. E. Liu
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  9. L. Vandenput
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  10. E. V. McCloskey
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Corresponding author

Correspondence to J. A. Kanis.

Ethics declarations

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

V Gudnason, G Sigurdsson, K Siggeirsdottir, E Liu, L Vandenput, and H Johansson have no competing interests to declare.

N. Harvey has received consultancy, lecture fees, and honoraria from the Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, UCB, Kyowa Kirin, Consilient Healthcare, Radius Health, and Internis Pharma.

EV McCloskey has received consultancy/lecture fees/grant funding/honoraria from AgNovos, Amgen, AstraZeneca, Consilient Healthcare, Fresenius Kabi, Gilead, GSK, Hologic, Internis, Lilly, Merck, Novartis, Pfizer, Radius Health, Redx Oncology, Roche, SanofiAventis, Servier, Synexus, UCB, Viiv, Warner Chilcott, I3 Innovus, and Unilever.

JA Kanis is the architect of FRAX® but has no financial interest.

M Lorentzon has received lecture fees from Amgen, Lilly, Meda, Renapharma, and UCB Pharma, and consulting fees from Amgen, Radius Health, UCB Pharma, Renapharma and Consilient Health, all outside the presented work

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Kanis, J.A., Johansson, H., Harvey, N.C. et al. The effect on subsequent fracture risk of age, sex, and prior fracture site by recency of prior fracture. Osteoporos Int 32, 1547–1555 (2021). https://doi.org/10.1007/s00198-020-05803-4

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  • DOI: https://doi.org/10.1007/s00198-020-05803-4

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