Risk of Major Osteoporotic Fracture (Hip, Vertebral, Radius, Humerus [MOF]) After First, Second and Third Fragility Fracture In A Swedish General Population Cohort

• Published in: VALUE IN HEALTH 2017-10, Vol.20 (9), p.A528
• Main Authors: Jonsson, E, Ström, O, Spångéus, A, Åkesson, K, Ljunggren, Ö, Borgström, F, Banefelt, J, Toth, E, Libanati, C, Charokopou, M
• Format: Article
• Language: English
• Subjects: Cohort analysis; Decision making; Demography; Fractured hips; Fractures; Hip; Humerus; Medicin och hälsovetenskap; National registers; Osteoporosis; Risk assessment; Risk factors; Vertebrae; Women
• ISSN: 1098-3015; 1524-4733; 1524-4733
• DOI: 10.1016/j.jval.2017.08.733

OBJECTIVES: Fracture is an established risk factor for future fracture and important for risk-assessment, economic modelling, and treatment decision-making. We estimated the risk of subsequent MOF following first, second and third fracture. METHODS: Women >50 years with >1 fracture between 2006-2012 (index date) were identified from national registers (1998-2015) and followed from first, second and third fracture. Women with a fracture at index were matched (1:3) with non-fracture controls, based on gender and age. Fracture risk was assessed by a parametric survival spline model with subsequent MOF as failure event, and controlled for nine known risk factors (comorbidities, treatment, demographic-related). RESULTS: 229,259 women (agemean=74 years) with one fracture, 36,465 (agemean=80 years) with two and 6,687 (agemean=83 years) with three were identified. Five-year cumulative incidence of subsequent MOF was 23.0% (CI95:22.7-23.4) after first fracture (index any site), 37.6% (CI95:36.1-39.1) after second, 21.2% (0195:18.0-25.0) after third, with the majority of subsequent fractures occurring in the first 2 years post fracture. Risk of subsequent MOF was highest in the first 6 months following index fracture; the adjusted relative risk (RR) of MOF was 2.2 (CI95:2.1-2.2) following any fragility fracture, 4.5 (CI95:4.2-4.9) following a vertebral fracture and 1.9 (CI95:1.8-2.1) following a hip fracture. After a second fracture, these RRs were 2.6 (CI95:2.4-2.8), 3.8 (CI95:2.9-5.2) and 2.0 (CI95:1.9-2.1); and after the third fracture, the RR was 1.5 (095:1.5-1.5). CONCLUSIONS: Fracture risk significantly increases rapidly within 6 months following a fragility fracture, remains very elevated in the subsequent 2 years and persists over 5 years. The relative risk manifests within 6 months and gradually declines over 5 years following the fracture. A patient who has suffered any fragility fracture requires prompt intervention to minimize that risk and avoid significant personal, economic and societal burden.