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Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study

Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study
Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study
Summary: prior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma. Introduction: some have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures. Methods: using a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise. Results: the study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08–1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47–1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture. Conclusions: high-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk.
Dual-energy X-ray absorptiometry, Fractures, Osteoporosis, Trauma
0937-941X
1059-1067
Leslie, W.D.
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Schousboe, J.T.
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Morin, S.N.
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Martineau, P.
b274885e-cd2e-404b-bf20-e49c50deb7e7
Lix, L.M.
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Johansson, H.
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McCloskey, E.V.
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Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, J.A.
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Leslie, W.D.
c877a5e5-98a4-43ad-9fbc-eb82f231eef1
Schousboe, J.T.
964f1e74-d6dc-4fec-bef4-4d00035bc3a7
Morin, S.N.
c579e9d3-8e52-4a8a-adeb-f2c1e9890346
Martineau, P.
b274885e-cd2e-404b-bf20-e49c50deb7e7
Lix, L.M.
843cf35c-724f-4d43-b0c1-477c152b9937
Johansson, H.
403f6163-8fad-4dc0-ba6d-1cdc4c00e6e8
McCloskey, E.V.
d3eb611f-b6a4-4032-8896-36f4411050c4
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, J.A.
767f1445-89cd-46f7-8fa9-903d740f1a8d

Leslie, W.D., Schousboe, J.T., Morin, S.N., Martineau, P., Lix, L.M., Johansson, H., McCloskey, E.V., Harvey, Nicholas and Kanis, J.A. (2020) Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study. Osteoporosis International, 31 (6), 1059-1067. (doi:10.1007/s00198-019-05274-2).

Record type: Article

Abstract

Summary: prior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma. Introduction: some have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures. Methods: using a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise. Results: the study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08–1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47–1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture. Conclusions: high-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk.

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Trauma vs low-trauma fracture_2019-12-12_OSIN.R2 main_ - Accepted Manuscript
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Accepted/In Press date: 29 December 2019
e-pub ahead of print date: 16 March 2020
Keywords: Dual-energy X-ray absorptiometry, Fractures, Osteoporosis, Trauma

Identifiers

Local EPrints ID: 439061
URI: http://eprints.soton.ac.uk/id/eprint/439061
ISSN: 0937-941X
PURE UUID: 9017691d-b960-4ee4-855e-c9c1b75d5c52
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 02 Apr 2020 16:32
Last modified: 26 Nov 2021 06:15

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Contributors

Author: W.D. Leslie
Author: J.T. Schousboe
Author: S.N. Morin
Author: P. Martineau
Author: L.M. Lix
Author: H. Johansson
Author: E.V. McCloskey
Author: Nicholas Harvey ORCID iD
Author: J.A. Kanis

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