Any initial fracture raises subsequent fracture risk for postmenopausal women
Click Here to Manage Email Alerts
Postmenopausal women who sustain any type of initial fracture are at a higher risk for a subsequent fracture, according to a study published in EClinicalMedicine.
“We need to change our frame of reference to understand that it is not just the hip, spine and wrist fractures that lead to future fractures in postmenopausal women,” Carolyn J. Crandall, MD, MS, FACP, a professor of medicine at David Geffen School of Medicine at University of California, Los Angeles, told Healio. “Rather, it’s each type of fracture that leads to higher risk of every other type of fracture, including hip fracture.”
Crandall and colleagues conducted a prospective analysis of fractures in 157,282 postmenopausal women (mean age, 63.1 years; 83% white) who participated in the Women’s Health Initiative and had follow-up data available. All fractures were self-reported except for hip fractures, which were confirmed through medical records. Age, race and ethnicity, education, smoking, alcohol intake, the number of falls in the past 12 months and medication use were collected through a baseline questionnaire.
About 30% of the study population experienced an incident fracture during a mean follow-up duration of 15.4 years. After adjusting for covariates, women with an initial fracture in the lower arm or wrist, upper arm or shoulder, upper leg, knee, lower leg or ankle, hip or pelvis, and vertebra had an increased risk for subsequent fracture in any area. The most pronounced association was a more than 27-fold risk increase for a subsequent upper leg fracture after an initial hip or pelvis fracture (adjusted HR = 27.18; 95% CI, 24.24-30.49).
The risk for a subsequent fracture was higher after an initial fracture for women aged 50 to 59 years, 60 to 69 years and 70 to 79 years. Women in the youngest age group had the highest increased risk and the oldest age group had the lowest risk. The risk for subsequent fracture after initial fracture varied by age in all areas except after an initial hip or pelvis fracture.
“Clinicians may be tempted not to pay much attention to fractures in younger postmenopausal women aged below 65 years,” Crandall said. “However, in our study, for each fracture location, even younger women in their 50s who experienced an initial fracture had a significantly higher risk of subsequent fracture. We think these findings will change how clinicians approach initial fractures in postmenopausal women.”
Risks for subsequent fracture also varied based on race or ethnicity. After an initial lower extremity fracture, the HR for subsequent fracture was higher in Black women (aHR = 14.32; 95% CI, 10.37-19.77), Hispanic/Latina women (aHR = 8.93; 95% CI, 6.34-12.57), and Asian/Pacific Islander women (aHR = 10.64; 95% CI, 6.69-16.94) than non-Hispanic white women (aHR = 7.48; 95% CI, 7.13-7.85). Similar associations were observed with initial upper extremity fracture.
“We need to do some detective work to figure out why the risks of subsequent fracture were higher in non-Hispanic Black, Hispanic/Latina and Asian/Pacific Islander women than among non-Hispanic white women,” Crandall said. “These results have public health implications because our current approach is likely missing a large burden of preventable fractures in Black, Hispanic and Asian/Pacific Islander women.”
For more information:
Carolyn J. Crandall, MD, MS, FACP, can be reached at ccrandall@mednet.ucla.edu.
Collapse
Click Here to Manage Email Alerts