This article is more than 5 years old. Information may no longer be current.
Risk for second fracture within 1 year nearly double in men vs. women
Click Here to Manage Email Alerts
Compared with women, men are at greater risk for a subsequent fracture, particularly within the first year and up to the first 3 years, after an initial major osteoporotic fracture, but refracture risk declines over time for both sexes, according to data presented at the American Society for Bone and Mineral Research Annual Meeting.
Suzanne N. Morin, MD, MSc, FRCP, FACP, associate professor in the department of medicine and an associate member of the divisions of endocrinology and general internal medicine at McGill University Health Centre in Montreal, and colleagues conducted a matched historical cohort study using linked administrative data on 17,721 men and 57,783 women from Manitoba, Canada, aged at least 50 years who experienced a major osteoporotic fracture between 1989 and 2006, and an age- and sex-matched control group (n = 165,965).
Researchers discovered a rate of subsequent fracture per 1,000 person-years of 18.5 in men (95% CI, 17.3-19.8) and 29.6 in women (95% CI, 28.8-30.4). Compared with controls, rate ratios were 2.5 (95% CI, 2.3-2.7) for men and 1.6 (95% CI, 1.6-1.7) for women up to 25 years of follow-up, with the researchers noting particularly greater risk for men in the first 3 years after initial fracture. HRs for a second fracture within 1 year were 3.3 (95% CI, 2.6-4.1) for men and 1.8 (95% CI, 1.7-2) for women and remained very elevated for men vs. women during the first 3 years. HRs at 15 years after the index fracture were 1.8 (95% CI, 1.4-2.4) for men and 1.5 (95% CI, 1.3-1.6) for women.
Fracture risks during 25 years of follow-up times were higher for those who had experienced a major osteoporotic fracture vs. controls, for both men and women, until age 80 years.
“These results underscore the importance of timely recognition of fracture events, especially in men, a population in whom secondary prevention is under-implemented,” Morin said in a press release. “This tells us we should be focusing on anti-fracture strategies early after the fracture event.” – by Phil Neuffer
Reference:
Morin S, et al. Abstract FRI-1038. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 28-Oct. 1, 2018; Montreal.
Disclosure: Morin reports no relevant financial disclosures.
Perspective
Back to TopEric Orwoll, MD, Professor of Medicine and Attending Physician
The importance of recognizing the implications of a fracture after age 50 years has been repeatedly emphasized. Those who suffer a fracture are clearly more likely to have additional fractures. Hence, devoting diagnostic, preventive and treatment efforts toward those patients has the potential to substantially reduce the overall burden of osteoporosis. Still, strategies to accomplish that goal (for instance with fracture liaison services) have not been widely adopted.
Morin and colleagues throw further light on this critical issue. In a study of more than 180,000 Canadian men and women aged at least 50 years, they show that after one fracture the risk of additional fractures is considerably higher than in those who have not fractured. That added risk was highest in the few years after a fracture and gradually declined thereafter but persisted for more than 15 years. In men, the added risk was particularly high shortly after a fracture — they were at least 3 times more likely to suffer additional fractures in the following year.
These results confirm previous reports and further emphasize the compelling need to focus clinical attention on fractures after age 50 years. In men, there is already a particularly large gap in osteoporosis care, and these data show that the need to recognize and act on these fractures is especially urgent. Moreover, the added risk apparently persists for a long period in both men and women, a fact that probably means the benefits of identification and clinical intervention remain for up to 15 years after a fracture. Every person who has had a fracture after age 50 deserves an evaluation and appropriate care to reduce the risk of additional fractures.
Click Here to Manage Email Alerts