Risk of subsequent fracture after prior fracture among older women

• Published in: Osteoporosis international Vol. 30; no. 1; pp. 79 - 92
• Main Authors: Balasubramanian, A., Zhang, J., Chen, L., Wenkert, D., Daigle, S. G., Grauer, A., Curtis, J. R.
• Format: Journal Article
• Language: English
• Published: London Springer London 01.01.2019; Springer Nature B.V
• Subjects: Age Distribution; Aged; Aged, 80 and over; Ankle; Clavicle; Disease management; Endocrinology; Female; Femur; Fibula; Follow-Up Studies; Fractures; Hip Fractures - epidemiology; Hip Fractures - etiology; Humans; Incidence; Medicare; Medicare - statistics & numerical data; Medicine; Medicine & Public Health; Older people; Original; Original Article; Orthopedics; Osteoporosis; Osteoporosis, Postmenopausal - complications; Osteoporosis, Postmenopausal - epidemiology; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - etiology; Pelvis; Recurrence; Retrospective Studies; Rheumatology; Risk Assessment - methods; Spinal Fractures - epidemiology; Spinal Fractures - etiology; Tibia; Time Factors; United States - epidemiology; Vertebrae; United States; Postmenopausal; Prevalence; Fracture risk assessment; Refracture; Fracture; Epidemiology; Fragility; Incidence; Osteoporosis; General population studies; Geriatric; Major osteoporotic fracture; Prediction modeling
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-018-4732-1

Summary Among 377,561 female Medicare beneficiaries who sustained a fracture, 10% had another fracture within 1 year, 18% within 2 years, and 31% within 5 years. Timely management to reduce risk of subsequent fracture is warranted following all nontraumatic fractures, including nonhip nonvertebral fractures, in older women. Introduction Prior fracture is a strong predictor of subsequent fracture; however, postfracture treatment rates are low. Quantifying imminent (12–24 month) risk of subsequent fracture in older women may clarify the need for early postfracture management. Methods This retrospective cohort study used Medicare administrative claims data. Women ≥ 65 years who sustained a clinical fracture (clinical vertebral and nonvertebral fracture; index date) and were continuously enrolled for 1-year pre-index and ≥ 1-year (≥  2 or ≥ 5 years for outcomes at those time points) post-index were included. Cumulative incidence of subsequent fracture was calculated from 30 days post-index to 1, 2, and 5 years post-index. For appendicular fractures, only those requiring hospitalization or surgical repair were counted. Death was considered a competing risk. Results Among 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5 years post-index, respectively. Among women age 65–74 years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women ≥ 75 years regardless of initial fracture site (except ankle and tibia/fibula), 7–14% fractured again within 1 year depending on initial fracture site; risk rose to 15–26% within 2 years and 28–42% within 5 years. Risk of subsequent hip fracture exceeded 3% within 5 years in all women studied, except those < 75 years with an initial tibia/fibula or ankle fracture. Conclusions We observed a high and early risk of subsequent fracture following a broad array of initial fractures. Timely management with consideration of pharmacotherapy is warranted in older women following all fracture types evaluated.