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Imminent risk of fracture after fracture

Imminent risk of fracture after fracture
Imminent risk of fracture after fracture
Summary: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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
0937-941X
775-780
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Siggeersdottir, K.
fb88d0e0-72f9-4f0b-a095-717b97c368e8
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Gundnason, V.
e3352566-cef0-4179-ab08-e222ab903634
McCloskey, E.
5211de37-303a-42f8-b24b-00c475264f78
Sigurdsson, G.
616bef02-3ddf-4172-a282-1be11212d240
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Johansson, H.
05aa5476-bcb9-4b97-905e-00f1dfd9d691
Siggeersdottir, K.
fb88d0e0-72f9-4f0b-a095-717b97c368e8
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Oden, A.
c018cdda-62cd-44a0-be3a-227484a568bb
Gundnason, V.
e3352566-cef0-4179-ab08-e222ab903634
McCloskey, E.
5211de37-303a-42f8-b24b-00c475264f78
Sigurdsson, G.
616bef02-3ddf-4172-a282-1be11212d240
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587

Johansson, H., Siggeersdottir, K., Harvey, Nicholas, Oden, A., Gundnason, V., McCloskey, E., Sigurdsson, G. and Kanis, J.A. (2017) Imminent risk of fracture after fracture. Osteoporosis International, 28 (3), 775-780. (doi:10.1007/s00198-016-3868-0). (PMID:28028554)

Record type: Article

Abstract

Summary: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: 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

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Accepted/In Press date: 1 December 2016
e-pub ahead of print date: 27 December 2016
Published date: March 2017
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 405696
URI: http://eprints.soton.ac.uk/id/eprint/405696
ISSN: 0937-941X
PURE UUID: b132c9a4-d557-4249-998e-660d7d97a363
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 10 Feb 2017 10:23
Last modified: 07 Oct 2020 05:48

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Contributors

Author: H. Johansson
Author: K. Siggeersdottir
Author: Nicholas Harvey ORCID iD
Author: A. Oden
Author: V. Gundnason
Author: E. McCloskey
Author: G. Sigurdsson
Author: J.A. Kanis

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