Give me a break

We know that having a low-trauma fracture increases the risk of subsequent fracture, yet less than 30% of postmenopausal women and less than 10% of men with prior fracture are given fracture-preventive therapy. How big is the risk of subsequent fracture? Most studies attempting to answer this question have focused on women and looked at a single fracture type (eg, hip). A group of researchers in Australia decided to look more broadly at this issue. They wanted to assess the absolute risk of any subsequent fracture following initial low-trauma fracture (fracture caused by a fall from standing height or lower) in both men and women.

Set in Australia, the prospective cohort study (Dubbo Osteoporosis Epidemiology Study) followed 2245 community-dwelling women and 1760 men aged 60 years or older who lived in the community from 1989 through 2005. Dubbo is a small city 400 km northwest of Sydney. Almost 99% of the population is white.

There were 905 women (40%) and 337 men (19%) who had initial low-trauma fractures. Of this group, 253 women and 71 men had subsequent fractures. The relative risk of subsequent fracture was 1.95 (95% confidence interval, 1.70–2.25) for women and 3.47 (95% confidence interval, 2.68–4.48) for men.

The absolute risk of subsequent fracture was similar for men and women and at least as great as the initial fracture risk for women 10 years older or for men 20 years older. This increase in absolute risk of fracture remained for up to 10 years. By this time, 40% to 50% of surviving men and women had subsequent fractures.

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

Bottom line

Low-trauma fracture is a signal for increased risk of all types of subsequent osteoporotic fractures, particularly in the 10 to 15 years after initial fracture.
Low-trauma fracture indicates the need for early fracture-preventive therapy.

Footnotes

Source: Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 2007;297:387–94.