Fractures occurring at any time in adulthood tied to risk for future fractures
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Key takeaways:
- A fracture at any point in adulthood was associated with elevated risk for future fractures.
- The results suggest that fractures in early adulthood should not be discounted when assessing fracture risk.
Fractures that occurred during adulthood were associated with risk for future fractures, regardless of age of fracture occurrence, according to cohort study results published in JAMA Network Open.
“Many studies investigating prior fracture as a risk factor for subsequent fracture focus on those occurring after middle to late adulthood. Consequently, nearly all the major fracture risk calculators, except [Fracture Risk Assessment Tool], have a lower age cutoff between 40 and 50 years when considering prior fractures,” Carrie Ye, MD, assistant professor in the department of medicine at the University of Alberta in Edmonton, Canada, and colleagues wrote. “However, it remains unclear whether fractures occurring before 40 to 50 years of age should also be considered when assessing an individual’s future risk of fracture.”
Ye and colleagues conducted an observational, population-based cohort study using data from 88,696 individuals (90.3% women; mean age, 64.6 years) from the Manitoba Bone Mineral Density Registry. All participants had a first BMD measurement between 1996 and March 2018. Researchers stratified individuals by age at first fracture before first DXA in 10-year intervals from age 20 to 29 years to 80 years or older.
The primary outcome was incident fractures occurring after DXA and before March 2021.
Overall, 23.8% of individuals had a prior fracture, with a mean age of 57.7 years at time of first fracture. During a mean follow-up of 9 years, 14.6% of individuals had incident fractures. Of these, 14% were osteoporotic, 10.6% were major osteoporotic and 3.5% were hip fractures.
Researchers observed higher risk for all incident, osteoporotic and major osteoporotic fractures, according to age at first fracture, after adjusting for sex and age. Adjusted HRs ranged from 1.55 (95% CI, 1.28-1.88) for age 70 to 79 years to 4.07 (95% CI, 2.99-5.52) for age 30 to 39 years at first fracture.
After adjusting for additional covariates, the HRs remained significantly elevated across all ages, ranging from 1.51 (95% CI, 1.42-1.6) for age 60 to 69 years to 2.12 (95% CI, 1.67-2.71) for age 20 to 29 years at first fracture.
“This finding contrasts with the commonly held notion that only adult fractures occurring at older ages are associated with increased risk of future fractures,” the researchers wrote. “Importantly, although the most commonly considered osteoporotic fractures were the most frequent prior fractures to occur after 50 years of age, other fractures made up the largest percentage of fractures in the three youngest age categories. This finding underscores the importance of assessing fractures beyond major osteoporotic fractures, consistent with a meta-analysis of previous studies that found that any prior fracture was associated with a similar increase in fracture risk as prior major osteoporotic fractures.”
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