Abstract
Fragility fractures constitute a major public health problem worldwide, causing important high morbidity and mortality rates. The aim was to present the epidemiology of fragility fractures and to assess the imminent risk of a subsequent fracture and mortality. This is a retrospective population-based cohort study (n = 1369) with a fragility fracture. We estimated the incidence rate of index fragility fractures and obtained information on the subsequent fractures and death during a follow-up of up to three years. We assessed the effect of age, sex, and skeletal site of index fracture as independent risk factors of further fractures and mortality. Incidence rate of index fragility fractures was 86.9/10,000 person-years, with highest rates for hip fractures in women aged ≥80 years. The risk of fracture was higher in subjects with a recent fracture (Relative Risk(RR), 1.80; p < 0.01). Higher age was an independent risk factor for further fracture events. Significant excess mortality was found in subjects aged ≥80 years and with a previous hip fracture (hazard ratio, 3.43 and 2.48, respectively). It is the first study in Spain to evaluate the incidence of major osteoporotic fractures, not only of the hip, and the rate of imminent fracture. Our results provide further evidence highlighting the need for early treatment.
Highlights
Fragility fractures caused by osteoporosis constitute a major public health problem worldwide
Our study provides an estimation of the incidence rate of subsequent fractures over 1–3 years following an index fracture
To distinguish subsequent fractures from previous events recorded at follow-up visits and/or patient history, the following criteria were applied: (1) Fractures in the same skeletal site of index fracture were only captured if a minimum of four months had elapsed since the index fracture; (2) hip fractures were only captured if an inpatient hospital admission was required; (3) all medical visits identified as follow-up examination of a previous fracture were excluded as further fracture events; (4) patients who died following a fracture were captured as having both outcomes; and (5) if the index fracture involved more than one skeletal sites, to avoid double counting, the fracture was assigned to the site of highest
Summary
Fragility fractures caused by osteoporosis constitute a major public health problem worldwide. Fragility fractures are an important cause of disability, morbidity, and mortality in the population [2]. A large number of risk factors for fragility fracture have been identified [3]. Older age is a well-defined clinical risk factor for fractures [15]. There is controversy between studies over its contribution on the risk of further fracture events. The predictive value of sex in the risk of further fracture events is controversial. Women were considered at higher risk of both initial and subsequent fracture and, some authors confirmed this hypothesis [11,16]. Other studies have not reported differences in the risk of subsequent fracture events between men and women [18,19]
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