SLR - August 2009 - Jeff Richardson
Reference:
Center, J., Bliue, D., Nguyen, T., Eisman, J. (2007). Risk of subsequent fracture after low trauma fracture in men and women. Journal of the American Medical Association, 297(4), 387-394.
Scientific Literature Reviews
Reviewed by: Jeff Richardson, DPM
Residency Program: University Hospitals Richmond Medical Center
Podiatric Relevance:
This study provides useful long-term data on absolute risk of subsequent fracture (refracture) of the lower extremity following an initial osteoporotic fracture in men and
women.
Methods:
Prospective cohort study in Australia of 2,245 community dwelling women and 1,760 men aged 60 years or older followed up for 16 years from July 1989 through April 2005. The patient assessment included smoking, alcohol and dietary calcium intake, number of falls within the last year, comorbid conditions and medication, anthropometric measurements, bone mineral density of the lumbar spine and femoral neck, quadriceps strength, and body sway. The circumstances surrounding each fracture were determined by personal interview by a study coordinator following each fracture. Only low trauma fracture caused by a fall from a standing height or less were included in the analysis. Fractures were classified according to site and either major or minor fractures. Major fractures included vertebrae, pelvis, distal femur, proximal tibia, rib and promixal humerus. Minor fractures included all remaining osteoporotic fractures. Incidence of first (initial) fracture and incidence of subsequent fracture according to sex, age group, and time since first fracture, and relative risk was determined by comparing risk of subsequent fracture with risk of initial fracture.
Results:
There were 905 women and 337 men with an initial fracture of whom 253 women and 71 men experienced a subsequent fracture. Relative risk of subsequent fracture in women was 1.95 (95% confidence interval, 1.70-2.25) and in men was 3.47 (95% confidence interval, 2.68-4.48). As a result, absolute risk of subsequent fracture was similar in women and men and at least as great as the initial fracture risk for a woman 10 years older. Thus, women and men 60-69 years had absolute re-fracture rates of 36/1000 person-years and 37/1000 person-years respectively. The increase in absolute fracture risk remain for up to 10 years by which time 40% to 60% of surviving women and men experience a subsequent fracture. All fracture locations apart from rib (men) and ankle (women) resulted in increase subsequent fracture risk with highest relative risks following hip and vertebral fractures in younger men. In multi-variate 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.
Conclusions:
After initial low trauma fracture, absolute risk of subsequent fracture was similar for men and women. This increased risk occurred for virtually all clinical fractures and persisted for up to 10 years. However, population diversity with different racial/ethnic groups should be included. Also different fracture types and groupings should be included as well. However, virtually all low-trauma fractures indicate the clinical need for re-fracture preventative therapy such as osteoporosis education and therapy.