After low-trauma fracture, older men and women have similar and substantial risk of subsequent fracture

Jan 23 2007

After sustaining an initial low-trauma fracture, older men and women have a similar and substantial risk of subsequent fracture, according to a study in the January 24/31 issue of JAMA: The Journal of the American Medical Association.

Despite substantial evidence that a prior fracture results in an increased risk of subsequent fracture, less than 30 percent of postmenopausal women and less than 10 percent of men with prior fracture are treated to help lower this risk. Although some of this deficiency in treatment is due to the overall lack of awareness of osteoporosis by the public and primary caregivers, the relative importance of prior fracture in relation to subsequent fracture risk does not appear to be fully appreciated, particularly in men, according to background information in the article. There are few published long-term studies on absolute risk of refracture in women, and fewer in men.

Jacqueline R. Center, M.B.B.S., Ph.D., of the Garvan Institute of Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, Australia, and colleagues examined absolute refracture risks for a variety of osteoporotic fracture types in a group of community-dwelling men (n = 1,760) and women (n = 2,245) age 60 years or older in Australia. The participants were followed up for 16 years, from July 1989 through April 2005.

There were 905 women and 337 men with an initial fracture, of whom 253 women and 71 men experienced a subsequent fracture. Women had nearly twice the risk of refracture, while men had 3.5 times the risk of refracture. The absolute risk of subsequent fracture was similar in women and men. The increase in absolute fracture risk remained for up to 10 years, by which time 40 percent to 60 percent of surviving women and men experienced a subsequent fracture.

For women, the absolute refracture risk was equivalent to or greater than the initial fracture risk of a woman 10 years older. For example, a 60- to 69-year-old woman with an initial fracture had an absolute refracture risk comparable to or greater than an initial fracture risk of a 70- to 79-year-old woman.

For men, the absolute risk of a subsequent fracture was similar to that of women and equivalent to or greater than an initial fracture risk of a woman 10 years older. For example, a 60- to 69-year-old man's absolute refracture risk was equivalent to or greater than a 70- to 79-year-old woman's initial fracture risk and similar to the initial risk of a man at least 20 years older.

All fracture locations apart from rib (men) and ankle (women) resulted in increased subsequent fracture risk, with highest risks following hip and clinical vertebral fractures in younger men. In further analyses, femoral neck bone mineral density, age, and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density, physical activity, and calcium intake were predictors in men.

"The critical clinical relevance of these findings is that any incident low-trauma fracture is a signal for increased risk of all types of subsequent osteoporotic fracture, particularly in the next 5 to 10 years. Thus, virtually all low-trauma fractures indicate the clinical need for fracture preventive therapy, and given the early peak of refracture, such preventive treatment should not be delayed. The lack of consideration of osteoporosis and treatment initiatives by the medical profession and the public, particularly in relation to men, should be the focus of education initiatives," the researchers conclude.