Characteristics of Recurrent Fractures

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2018 Jun 28

PMID 29947869

Citations 74

Authors

J A Kanis

H Johansson

A Oden

N C Harvey

V Gudnason

K M Sanders

G Sigurdsson

K Siggeirsdottir

L A Fitzpatrick

F Borgstrom

E V McCloskey

Affiliations

Soon will be listed here.

Abstract

Introduction: The risk of a subsequent osteoporotic fracture is particularly acute immediately after an index fracture and wanes progressively with time. The aim of this study was to quantify the risk and utility consequences of subsequent fracture after a sentinel fracture (at the hip, spine, distal forearm and humerus) with an emphasis on the time course of recurrent fracture.

Methods: The Reykjavik Study fracture registration, drawn from a sample of the Icelandic population (n = 18,872), recorded all fractures of the participants from their entry into the study until December 31, 2012. Medical records for the participants were manually examined and verified. First sentinel fractures were identified. Subsequent fractures, deaths, 10-year probability of fracture and cumulative disutility using multipliers derived from the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS) were examined as a function of time after fracture, age and sex.

Results: Over 10 years, subsequent fractures were sustained in 28% of 1498 individuals with a sentinel hip fracture. For other sentinel fractures, the proportion ranged from 35 to 38%. After each sentinel fracture, the risk of subsequent fracture was highest in the immediate post fracture interval and decreased markedly with time. Thus, amongst individuals who sustained a recurrent fracture, 31-45% did so within 1 year of the sentinel fracture. Hazard ratios for fracture recurrence (population relative risks) were accordingly highest immediately after the sentinel fracture (2.6-5.3, depending on the site of fracture) and fell progressively over 10 years (1.5-2.2). Population relative risks also decreased progressively with age. The utility loss during the first 10 years after a sentinel fracture varied by age (less with age) and sex (greater in women). In women at the age of 70 years, the mean utility loss due to fractures in the whole cohort was 0.081 whereas this was 12-fold greater in women with a sentinel hip fracture, and was increased 15-fold for spine fracture, 4-fold for forearm fracture and 8-fold for humeral fracture.

Conclusion: High fracture risks and utility loss immediately after fracture suggest that treatment given as soon as possible after fracture would avoid a higher number of new fractures compared with treatment given later. This provides the rationale for very early intervention immediately after a sentinel fracture.

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References

Klotzbuecher C, Ross P, Landsman P, Abbott 3rd T, Berger M . Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000; 15(4):721-39. DOI: 10.1359/jbmr.2000.15.4.721. View

Johansson H, Siggeirsdottir K, Harvey N, Oden A, Gudnason V, McCloskey E . Imminent risk of fracture after fracture. Osteoporos Int. 2016; 28(3):775-780. PMC: 5338733. DOI: 10.1007/s00198-016-3868-0. View

Bonafede M, Shi N, Barron R, Li X, Crittenden D, Chandler D . Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data. Arch Osteoporos. 2016; 11(1):26. PMC: 4967418. DOI: 10.1007/s11657-016-0280-5. View

Kanis J, McCloskey E, Johansson H, Cooper C, Rizzoli R, Reginster J . European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2012; 24(1):23-57. PMC: 3587294. DOI: 10.1007/s00198-012-2074-y. View

Lindsay R, Silverman S, Cooper C, Hanley D, Barton I, Broy S . Risk of new vertebral fracture in the year following a fracture. JAMA. 2001; 285(3):320-3. DOI: 10.1001/jama.285.3.320. View

Kanis J, Johnell O, De Laet C, Johansson H, Oden A, Delmas P . A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004; 35(2):375-82. DOI: 10.1016/j.bone.2004.03.024. View

Oden A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis J . Lifetime risk of hip fractures is underestimated. Osteoporos Int. 1999; 8(6):599-603. DOI: 10.1007/s001980050105. View

Tidermark J, Bergstrom G . Responsiveness of the EuroQol (EQ-5D) and the Nottingham Health Profile (NHP) in elderly patients with femoral neck fractures. Qual Life Res. 2006; 16(2):321-30. DOI: 10.1007/s11136-006-9004-4. View

Svedbom A, Borgstrom F, Hernlund E, Strom O, Alekna V, Bianchi M . Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS. Qual Life Res. 2017; 27(3):707-716. DOI: 10.1007/s11136-017-1748-5. View

10.

Nymark T, Lauritsen J, Ovesen O, Rock N, Jeune B . Short time-frame from first to second hip fracture in the Funen County Hip Fracture Study. Osteoporos Int. 2006; 17(9):1353-7. DOI: 10.1007/s00198-006-0125-y. View

11.

Lyles K, Colon-Emeric C, Magaziner J, Adachi J, Pieper C, Mautalen C . Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007; 357(18):1799-809. PMC: 2324066. DOI: 10.1056/NEJMoa074941. View

12.

Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P . Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977-2001. J Bone Miner Res. 2009; 24(7):1299-307. DOI: 10.1359/jbmr.090207. View

13.

Dolan P . Modeling valuations for EuroQol health states. Med Care. 1997; 35(11):1095-108. DOI: 10.1097/00005650-199711000-00002. View

14.

van Geel T, van Helden S, Geusens P, Winkens B, Dinant G . Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis. 2008; 68(1):99-102. DOI: 10.1136/ard.2008.092775. View

15.

van Helden S, Wyers C, Dagnelie P, van Dongen M, Willems G, Brink P . Risk of falling in patients with a recent fracture. BMC Musculoskelet Disord. 2007; 8:55. PMC: 1933426. DOI: 10.1186/1471-2474-8-55. View

16.

Breslow N, Day N . Statistical methods in cancer research. IARC Workshop 25-27 May 1983. IARC Sci Publ. 1987; (82):1-406. View

17.

Siggeirsdottir K, Aspelund T, Sigurdsson G, Mogensen B, Chang M, Jonsdottir B . Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based fracture registry. Eur J Epidemiol. 2007; 22(9):631-9. DOI: 10.1007/s10654-007-9163-9. View

18.

Olerud P, Tidermark J, Ponzer S, Ahrengart L, Bergstrom G . Responsiveness of the EQ-5D in patients with proximal humeral fractures. J Shoulder Elbow Surg. 2011; 20(8):1200-6. DOI: 10.1016/j.jse.2011.06.010. View

19.

Giangregorio L, Leslie W . Time since prior fracture is a risk modifier for 10-year osteoporotic fractures. J Bone Miner Res. 2010; 25(6):1400-5. DOI: 10.1002/jbmr.35. View

20.

Kanis J, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A . The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int. 2001; 12(5):417-27. DOI: 10.1007/s001980170112. View