Recent major osteoporotic fracture risk for refracture at 10 years
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Among women aged 40 to 64 years, a recent major osteoporotic fracture was associated with increased risk for a repeat fracture at 10 years, with highest risk within the first 2 years of the fracture, according to study data.
“Our findings contribute to accumulating evidence of the importance of recent fracture,” William D. Leslie, MD, MSc, professor of medicine and radiology at the University of Manitoba in Winnipeg, Canada, and colleagues wrote.
For the study, researchers used the Fracture Risk Assessment Tool (FRAX) to estimate 10-year fracture probability for major osteoporotic fracture and hip fracture, and the population-based Manitoba Bone Mineral Density Program registry to determine the impact of recent fracture and site on incident fracture risk predictions. They identified women (aged ≥ 40 years) with baseline BMD information and FRAX scores and compared observed fracture outcomes to 10 years with predicted 10-year fracture probability.
Fracture probability was stratified via prior fracture status: none; recent, defined as within 2 years of baseline (median, 0.3 years); and remote, defined as at least 2 years before baseline (median, 10.6 years). Additionally, researchers assessed proposed multipliers to adjust FRAX for the effect of fracture recency and site for women with recent fractures.
The study included 33,465 women (aged 40 to 64 years) with 1,897 recent fractures and 2,120 remote fractures, and 33,806 women (aged ≥ 65 years) with 2,365 recent fractures and 4,135 remote fractures.
Results indicated consistency between observed fracture probability and predicted probability in most analyses.
Among women younger than 65 years, major osteoporotic fracture in the prior 2 years, vs. no initial fracture, resulted in an adjusted OR for repeat major osteoporotic fracture of 2.86 (95% CI, 2.13-3.84), which proved greater (P = .012) than if the fracture occurred more than 2 years previously (OR = 1.68; 95% CI, 1.19-2.37). For women aged 65 years or older, Leslie and colleagues found the OR for recent prior major osteoporotic fracture (1.99; 95% CI, 1.62-2.45) was not greater (P = .3) than if the fracture occurred more than 2 years previously (OR = 1.76; 95% CI 1.48-2.1).
Furthermore, researchers reported a significant effect of recent vertebral (observed to predicted, 1.61) and humerus (observed to predicted, 1.48) fracture on major osteoporotic fracture; however, these effects were lesser than the proposed multipliers of 2.32 for vertebral and 1.67 for humerus.
There was no significant effect of fracture recency after hip or forearm fracture in either age group.
Leslie and colleagues noted that although the findings provide further evidence for the excess fracture risk associated with recent fracture, the effect of fracture recency was not consistent across fracture sites and with a lower magnitude than in recent estimates from the Reykjavik cohort.
“Further quantification of effect size and specificity in additional independent cohorts is warranted to validate and refine recent-fracture multipliers in fracture risk assessment,” they wrote. “Meanwhile, a first fracture should continue to be regarded as a major risk factor for a second fracture and calls for a thorough clinical evaluation and appropriate initiation of nonpharmacologic interventions, medications and falls prevention to reduce that risk.”
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