Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study

Cyril MJR Schreurs,Arnold DM Kester,Ivo F Nagtzaam,Antonia CM van Geel,Paula ELM Rinkens,Danny JM van der Voort,Piet P Geusens,Geert-Jan Dinant

doi:10.1186/1741-7015-4-24

Abstract

BackgroundMany risk factors for fractures have been documented, including low bone-mineral density (BMD) and a history of fractures. However, little is known about the short-term absolute risk (AR) of fractures and the timing of clinical fractures. Therefore, we assessed the risk and timing of incident clinical fractures, expressed as 5-year AR, in postmenopausal women.MethodsIn total, 10 general practice centres participated in this population-based prospective study. Five years after a baseline assessment, which included clinical risk factor evaluation and BMD measurement, 759 postmenopausal women aged between 50 and 80 years, were re-examined, including undergoing an evaluation of clinical fractures after menopause. Risk factors for incident fractures at baseline that were significant in univariate analyses were included in a multivariate Cox survival regression analysis. The significant determinants were used to construct algorithms.ResultsIn the total group, 12.5% (95% confidence interval (CI) 10.1–14.9) of the women experienced a new clinical fracture. A previous clinical fracture after menopause and a low BMD (T-score <-1.0) were retained as significant predictors with significant interaction. Women with a recent previous fracture (during the past 5 years) had an AR of 50.1% (95% CI 42.0–58.1) versus 21.2% (95% CI 20.7–21.6) if the previous fracture had occurred earlier. In women without a fracture history, the AR was 13.8% (95% CI 10.9–16.6) if BMD was low and 7.0% (95% CI 5.5–8.5) if BMD was normal.ConclusionIn postmenopausal women, clinical fractures cluster in time. One in two women with a recent clinical fracture had a new clinical fracture within 5 years, regardless of BMD. The 5-year AR for a first clinical fracture was much lower and depended on BMD.

Highlights

Many risk factors for fractures have been documented, including low bone-mineral density (BMD) and a history of fractures
The resulting hospital costs alone amount to over US$3976 million in the European Union, US$500 million in Australia, US$5700 million in the USA, and US$9359 million in Japan [10]. In view of this high morbidity, mortality and economic burden, it is important to identify those groups of patients who are at high risk and for whom interventions to prevent osteoporotic fractures would be most effective [3,4,69]
Non-participating women were compared with participating women in terms of the baseline variables

Summary

Introduction

Many risk factors for fractures have been documented, including low bone-mineral density (BMD) and a history of fractures. The worldwide lifetime risk of osteoporotic fractures in women is 40%, and because of the ageing of the population, the overall prevalence of osteoporotic fractures is expected to rise considerably [10]. The resulting hospital costs alone amount to over US$3976 million in the European Union, US$500 million in Australia, US$5700 million in the USA, and US$9359 million in Japan [10]. In view of this high morbidity, mortality and economic burden, it is important to identify those groups of patients who are at high risk and for whom interventions to prevent osteoporotic fractures would be most effective [3,4,69]

Objectives

Methods

Results

Discussion

Conclusion