Mechanisms for increased systemic fracture risk after index fracture

Abstract

The single best predictor of future fracture risk is a prior fracture at any skeletal site. However, the mechanisms underlying this relationship remain incompletely understood. Here we review three potential mechanisms underlying increased risk. An index fracture may reflect preexisting deficits in bone quality or impairments in physical function. Second, fracture may cause biomechanical changes that increase future fracture risk. Third, fracture induces a period of systemic bone loss that is never fully recovered. Further investigation into these mechanisms can inform treatments that prevent future fractures for individuals with a prior history of fracture.