Risk Factor For Subsequent Fracture Research Articles

A meta-analysis of previous falls and subsequent fracture risk in cohort studies.

Previous falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD). The resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Falls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33-1.51) and men (HR 1.53, 95% CI 1.41-1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27-1.84) in men vs. HR 1.32 (95% CI 1.20-1.45) in women, P for interaction = 0.013). The HRs associated with previous falls decreased with age in women and with duration of follow-up in men and women for most fracture outcomes. There was no evidence of an interaction between falls and BMD for fracture risk. Subsequent risk for a major osteoporotic fracture increased with each additional previous fall in women and men. A previous self-reported fall confers an increased risk of fracture that is largely independent of BMD. Previous falls should be considered as an additional risk factor in future iterations of FRAX to improve fracture risk prediction.

Spinal Sagittal Imbalance is Associated with Vertebral Fracture without a Definite History of Falls: Cross-Sectional, Comparative Study of Cohort with and without a Distal Radius Fracture

Background: Treating osteoporosis in patients with a distal radius fracture (DRF) became paramount at the Fracture Liaison Service. Spinal sagittal imbalance emerged as a risk factor for subsequent fractures. Therefore, here we investigated the spinal profile of patients with DRF to investigate its association with a history of falls and prevalent vertebral fractures.Methods: We reviewed the cases of 162 women presenting with DRF and 162 age-matched women without fracture who underwent an osteoporosis evaluation including bone mineral density (BMD) and lateral spine imaging. We compared the incidence of prevalent vertebral fracture and sagittal vertical axis (SVA) to measure spinal sagittal imbalance. We also performed a regression analysis of the risks of prevalent vertebral fracture, such as age, body mass index (BMI), BMD, and SVA.Results: The SVA was significantly smaller (indicating more stable sagittal balance) in patients with a DRF versus controls (16 mm vs. 34 mm, respectively; <i>p</i><0.001). The incidence of a prevalent vertebral fracture was similar between groups (12% vs. 15%, respectively; <i>p</i>=0.332). In both groups, the SVA was significantly greater in those with versus without a vertebral fracture. The vertebral fracture was significantly associated with age and SVA but not BMI or spinal BMD.Conclusions: Spinal sagittal balance was superior in DRF patients, yet the frequency of prevalent vertebral fractures was similar. The identification of this unique spinal profile in patients with DRF may increase our understanding of osteoporotic fractures.

Risk factors for refracture after proximal femur fragility fracture.

Proximal femur fragility fractures (PFFFs) are a growing worldwide concern. Recognizing the risk factors for subsequent fracture is essential for secondary prevention. This study aimed to analyze the risk factors for refracture and mortality rates in patients who suffered a PFFF. Patients aged 65 years or older with PFFF who underwent surgical treatment during the year of 2017 in the same institution were retrospectively analyzed and at least four years after the index fracture were evaluated. From a total of 389 patients, 299 patients were included, with a median age of 83 years, and 81% female. Thirty-two (10.7%) suffered a refracture, with a mean time to refracture of 19.8 ± 14.80 months, being the female sex a risk factor for refracture (OR-4.69; CI [1.05-20.95]). The 1-year mortality rate was 15.4%. Seventy-three (24.4%) patients had previous fragility fractures. After the index fracture, 79% remained untreated for osteoporosis. No statistical association was found between antiosteoporotic treatment and refracture. Patients with refracture had higher prefracture functional level compared with patients without refracture (OR-1.33; CI [1.08-1.63]) and were discharged more often to rehabilitation units (31% versus 16%, P =.028). After 4 years of follow-up, patients with refracture had lower functional level compared with patients without. Chronic kidney disease was a risk factor (P = .029) for early refracture (<24 months). Female sex and higher prefracture functional level may increase the risk of refracture. Chronic kidney disease was associated with a shorter refracture time. Despite having a PFFF or other fragility fractures, the majority of patients remained untreated for osteoporosis.

The risk factors for subsequent fractures after distal radius fracture.

The purpose of this study was to evaluate the risk factors for subsequent fractures after distal radius fracture (DRF). We retrospectively reviewed 705 patients with DRF who performed dual-energy X-ray absorptiometry within six months before or after the DRF and followed more than 12months. We identified patients with subsequent fractures and multivariate logistic regression analyses were conducted with demographic information, underlying disease status, and bone fragility parameters at the time of DRF to evaluate the risk factors for subsequent fractures. Subsequent fractures occurred in 56 patients (7.9% of 705 patients) with 65 fractures at a mean time of 33.5months after DRF. In multivariate logistic regression analysis, older age (OR 1.032; 95% CI, 1.001-1.064, p = 0.044), diabetes mellitus (DM) (OR 2.663; 95% CI, 1.429-4.963, p = 0.002) and previous fracture history (OR 1.917; 95% CI, 1.019-3.607, p = 0.043), and low total hip BMD (OR 1.410; 95% CI, 1.083-1.836, p = 0.011) were significant risk factors for the occurrence of subsequent fractures. This study demonstrated that older age, DM, previous fracture history and low hip BMD are the risk factors for subsequent fractures after DRF. Active glycemic control would have a role in patients with DM and a more aggressive treat-to-target approach may be necessary for patients with low BMDs to prevent subsequent fractures after DRF.

A retrospective observational study of osteoporosis management after a fragility fracture in primary care

SummaryIn many countries, osteoporosis is predominantly managed by primary care physicians; however, management after a fragility fracture has not been widely investigated. We describe osteoporosis care gaps in a real-world patient cohort. Our findings help inform initiatives to identify and overcome obstacles to effective management of patients after fragility fracture.PurposeA fragility fracture is a major risk factor for subsequent fracture in adults aged ≥ 50 years. This retrospective observational study aimed to characterize post-fracture management in Canadian primary care.MethodsA total of 778 patients with an index fragility fracture (low-trauma, excluding small bones) occurring between 2014 and 2016 were identified from medical records at 76 primary care centers in Canada, with follow-up until January 2018.ResultsOf 778 patients (80.5% female, median age [IQR] 73 [64–80]), 215 were on osteoporosis treatment and 269 had osteoporosis diagnosis recorded prior to their index fracture. The median follow-up was 363 (IQR 91–808) days. Of patients not on osteoporosis treatment at their index fracture, 60.2% (n = 339/563) remained untreated after their index fracture and 62.2% (n = 23/37) continued untreated after their subsequent fracture. After their index fracture, fracture risk assessment (FRAX or CAROC) was not performed in 83.2% (n = 647/778) of patients, and 59.9% (n = 466/778) of patients did not receive bone mineral density testing. Of patients without osteoporosis diagnosis recorded prior to their index date, 61.3% (n = 300/489) remained undiagnosed after their index fracture. At least one subsequent fracture occurred in 11.5% (n = 86/778) of patients.ConclusionIn the primary care setting, fragility fracture infrequently resulted in osteoporosis treatment or fracture risk assessment, even after multiple fragility fractures. These results suggest a fragility fracture is not recognized as a major risk factor for subsequent fracture and its occurrence does not prompt primary care physicians to intervene. These data urge initiatives to identify and overcome obstacles to primary care physicians’ effective management of patients after fragility fractures.

Assessment of clinical, imaging, surgical risk factors for subsequent fracture following vertebral augmentation in osteoporotic patients.

Currently, the risk factors for subsequent fracture following vertebral augmentation remain incomplete and controversial. To provide clinicians with accurate information for developing a preventive strategy, we carried out a comprehensive evaluation of previously controversial and unexplored risk factors. We retrospectively reviewed patients with osteoporotic vertebral compression fracture in lumbar spine who received vertebral augmentation between January 2019 and December 2020. Based on whether refracture occurred, patients were assigned to refracture and non-refracture group. The clinical characteristics, imaging parameters (severity of vertebral compression, spinal sagittal alignment, degeneration of paraspinal muscles), and surgical indicators (cement distribution and leakage, correction of spinal sagittal alignment) were collected and analyzed. There were 128 patients and 16 patients in non-refracture and refracture group. The incidence of previous fracture, multiple fractures, and cement leakage were notably higher, relative cross-sectional area of psoas (r-CSAPS) was significantly smaller, CSA ratio, fatty infiltration of erector spinae plus multifidus (FIES+MF), FIPS, postoperative lumbar lordosis (post-LL), correction of body angel (BA), and LL were significantly greater in refracture group. Binary logistic regression analysis revealed previous fracture, cement leakage, post-LL, and correction of BA were independent risk factors. According to the ROC curve, correction of BA showed the highest prediction accuracy, and the critical value was 3.45°. The occurrence of subsequent fracture might be the consequence of multiple factors. Previous fracture, cement leakage, post-LL, and correction of BA were identified as independent risk factors. Furthermore, the correction of BA should not exceed 3.45°, especially in patients with risk factors.

What are risk factors for subsequent fracture after vertebral augmentation in patients with thoracolumbar osteoporotic vertebral fractures

BackgroundDue to its unique mechanical characteristics, the incidence of subsequent fracture after vertebral augmentation is higher in thoracolumbar segment, but the causes have not been fully elucidated. This study aimed to comprehensively explore the potential risk factors for subsequent fracture in this region.MethodsPatients with osteoporotic vertebral fracture in thoracolumbar segment who received vertebral augmentation from January 2019 to December 2020 were retrospectively reviewed. Patients were divided into refracture group and non-refracture group according to the occurrence of refracture. The clinical information, imaging findings (cement distribution, spine sagittal parameters, degree of paraspinal muscle degeneration) and surgery related indicators of the included patients were collected and compared.ResultsA total of 109 patients were included, 13 patients in refracture group and 96 patients in non-refracture group. Univariate analysis revealed a significantly higher incidence of previous fracture, intravertebral cleft (IVC) and cement leakage, greater fatty infiltration of psoas (FIPS), fatty infiltration of erector spinae plus multifidus (FIES + MF), correction of body angle (BA), BA restoration rate and vertebral height restoration rate in refracture group. Further binary logistic regression analysis demonstrated previous fracture, IVC, FIPS and BA restoration rate were independent risk factors for subsequent fracture. According to ROC curve analysis, the prediction accuracy of BA restoration rate was the highest (area under the curve was 0.794), and the threshold value was 0.350.ConclusionsSubsequent fracture might cause by the interplay of multiple risk factors. The previous fracture, IVC, FIPS and BA restoration rate were identified as independent risk factors. When the BA restoration rate exceeded 0.350, refractures were more likely to occur.

Osteoporotic fractures and subsequent fractures: imminent fracture risk from an analysis of German real-world claims data

PurposeIn osteoporosis, prior fracture is a strong predictor of subsequent fracture. This study aimed to assess the imminent risk of subsequent fracture following an initial fracture in osteoporosis patients in Germany, and to identify clinical and demographic characteristics that are independently associated with subsequent fracture risk.MethodsIn this retrospective, observational cohort study using German real-world claims data, male and female patients aged ≥ 50 years with osteoporosis who experienced an initial (“index”) hip/femur, vertebral, forearm/wrist/hand or shoulder/upper arm fracture between 2010 and 2014 were included. The incidence and timing of subsequent fractures during a 1-year follow-up period were analyzed. Independent risk factors for subsequent fracture were identified by multivariate regression analysis.ResultsA total of 18,354 patients (mean age: 77 years; standard deviation: 9.8) were included. Of these, 2918 (15.9%) suffered a subsequent fracture during the 1-year follow-up period. The incidence of subsequent fracture was higher following an index vertebral fracture (18.0%) than after an index forearm/wrist/hand fracture (14.1%) or index hip/femur fracture (12.1%). Subsequent 1-year fracture incidence was generally higher in older patients. Index fracture type, age, epilepsy/use of antiepileptics, and heart failure were all independently associated with subsequent fracture risk.ConclusionOsteoporosis patients in Germany are at imminent risk of subsequent fracture during the first year following an initial fracture. They should be targeted for immediate post-fracture treatment to reduce the risk of further fractures, especially in the presence of specific risk factors such as old age or index vertebral fracture.

Incidence and risk factors of subsequent osteoporotic fracture: a nationwide cohort study in South Korea.

To identify and analyze the incidence and risk factors of subsequent osteoporotic fractures in South Korea. This retrospective cohort study analyzed data from the National Health Insurance Review and Assessment claims database from 2012 to 2017. Men and women with osteoporosis, aged ≥50 years, with index fractures between July 1, 2014, and July 1, 2015, were included. The incidence rate of subsequent fractures was calculated by determining the number of second event within 2 years from the index fracture. To identify the risk factors for subsequent fractures, we applied the Cox proportional hazard model to estimate the hazard ratios (HRs). Of the 73,717 patients with osteoporotic fractures, 13,203 (17.91%) had a subsequent fracture. The incidence rate of subsequent fractures within 24 months was 10.23/100 person-years. The index fracture site was a significant risk factor for a subsequent fracture, with the hip showing the highest risk (HR, 7.51; 95% confidence interval [CI], 6.77-8.34), followed by the vertebra (HR, 1.99; 95% CI, 1.91-2.06). The risk of subsequent fractures increased with a higher Charlson Comorbidity Index (CCI) score (CCI score ≥ 5: HR, 1.79; 95% CI, 1.67-1.92). The incidence rate of subsequent osteoporotic fractures in South Korea is similar or higher than that reported in the USA and Europe. A hip fracture within the prior 2 years, relative to other fracture sites, significantly increased the risk of subsequent fractures in osteoporosis patients. Patients who have these risk factors need closer disease management to prevent subsequent fractures.

The Association between Fast Increase in Bone Turnover During the Menopause Transition and Subsequent Fracture.

Bone turnover increases rapidly during the menopause transition (MT) and plateaus above premenopausal levels in early postmenopause. It is uncertain whether higher bone turnover is associated with fracture in midlife women with near-normal bone mineral density (BMD). Examine whether faster increases in bone turnover during the MT (2 years before to 2 years after the final menstrual period [FMP]), and greater bone turnover during early postmenopause (≥2 years after the FMP) are risk factors for subsequent fracture, accounting for BMD. The Study of Women's Health Across the Nation, a longitudinal cohort study of the MT. A total of 484 women (initially pre- or early perimenopausal, who transitioned to postmenopause) with bone turnover (urine collagen type I N-telopeptide), BMD, and fracture data. Incident fracture after the MT. Adjusting for age, race/ethnicity, fracture before the MT, cigarette use, body mass index, and study site in Cox proportional hazards regression, each SD increment in the rate of increase in bone turnover during the MT was associated with 24% greater hazard of incident fracture in postmenopause (P = .008). Accounting for the same covariates, each SD increment in bone turnover during early postmenopause was associated with a 27% greater hazard of fracture (P = .01). Associations remained significant after controlling for MT rate of change and early postmenopausal level of BMD. Faster increases in bone turnover during the MT and greater bone turnover in early postmenopause forecast future fractures.

Risk of imminent fracture following a previous fracture in a Swedish database study

SummaryThis study examined the imminent risk of a future fracture within 1 and 2 years following a first fracture in women aged 50 years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures.IntroductionThis study aims to determine the imminent risk of subsequent fractures within 1 and 2 years following a first fracture and to assess independent factors associated with subsequent fractures.MethodsRetrospective, observational cohort study of women aged ≥ 50 years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24 months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis.ResultsTwo hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12 months was 7.1% (95% confidence interval [CI], 6.9–7.2) and at 24 months was 12.0% (95% CI, 11.8–12.1). The rate of subsequent fractures was highest in the first month (~ 15 fractures per 1000 patient-years) and remained steady between 4 and 24 months (~ 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24 months, sub-distribution hazard ratio [HR], 3.07; p < 0.001 for women 80–89 years [reference 50–59 years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p < 0.001 over 12 months; HR, 2.23; p < 0.001 over 24 months).ConclusionsOur findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.

Increased risk of fracture in patients with bipolar disorder: a nationwide cohort study.

Bipolar disorder (BD) is a systemic inflammatory disease, and disrupted bone metabolism due to the inflammatory process can cause fracture. Despite evidence of an association between lower bone mineral density and an increased risk of fracture among patients with depression, schizophrenia, and anorexia nervosa, whether BD is a risk factor for subsequent fracture is unknown. To determine the association between BD and fracture and to examine the risk factors for fracture among patients with BD. In this study, we enrolled patients diagnosed with BD from the Taiwan National Health Insurance Research Database. Patients newly diagnosed with BD (ICD-9-CM 296) from 2001 to 2008 were included in the BD cohort, and the date of the initial diagnosis of BD was used as the index date. The comparison cohort, comprising participants without BD, was frequency matched to the BD cohort by age, sex, and index year, and the occurrence of fracture was evaluated in both cohorts. The BD and comparison cohorts were comprised of 47,271 patients with BD and 1,89,084 frequency-matched participants without BD, respectively. The incidence of fracture was higher among patients with BD than among the controls. Cox models showed that BD was an independent risk factor for fracture irrespective of comorbidities [hazard ratio (HR)=1.79, 95% confidence interval (CI)=1.73-1.84, p<.001]. Our study showed that patients with BD have a higher risk of subsequent fracture. Additional prospective clinical studies investigating the relationship between BD and fracture are warranted.

Potential Risk Factors for Subsequent Fractures according to Treatment of Primary Osteoporotic Vertebral Fractures

Materials and Methods: 57 patients who had undergone follow-up magnetic resonance imaging (MRI) of the spine were divided into two groups depending on the development of subsequent vertebral fractures: the fracture group with 40 cases and the non-fracture group with 17 cases. The patients’ clinical and radiographic data including bone mineral density, medication for osteoporosis, body mass index, vertebroplasty of primary vertebral fractures, thoracic kyphotic angle and lumbar lordotic angle, fat infiltration of the back extensor muscle, and primary multiple fractures were examined. Results: The subsequent new vertebral fractures occurred at a mean of 24 ± 19 months after primary osteoporotic vertebral fractures. Vertebroplasty for primary fractures was associated with a higher incidence of subsequent new vertebral fractures (p=0.001). There was a significant increase in fat infiltration of the back extensor muscle after the primary vertebral fractures in the fracture group (p=0.001). A multiple logistic regression analysis showed the significance of vertebroplasty (odds’ ratio: 4.623, 95% confidence interval: 1.145–18.699, p=0.031). Conclusions: These results suggest that vertebroplasty for primary vertebral fractures and increased fat infiltration of the back extensor muscle could be risk factors related to the development of subsequent osteoporotic vertebral fractures.

Bone mineral density predicts fractures in chronic kidney disease.

Fractures are common in chronic kidney disease (CKD). The optimal methods by which to assess fracture risk are unknown, in part, due to a lack of prospective studies. We determined if bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), and/or high-resolution peripheral quantitative computed tomography (HRpQCT) could predict fractures in men and women ≥18 years old with stages 3 to 5 CKD. BMD was measured by DXA (at the total hip, lumbar spine, ultradistal, and 1/3 radius) and by HRpQCT (at the radius), and subjects were followed for 2 years for incident morphometric spine fractures and low-trauma clinical fractures. The mean age of the subjects was 62 years with equal numbers having stages 3, 4, and 5 CKD. Over 2 years there were 51 fractures in 35 subjects. BMD by DXA at baseline was significantly lower at all sites among those with incident fractures versus those without. For example, the mean BMD at the total hip in those with incident fractures was 0.77 g/cm2 (95% confidence interval [CI], 0.73 to 0.80) and in those without fracture was 0.95 g/cm2 (95% CI, 0.92 to 0.98). Almost all baseline HRpQCT measures were lower in those with incident fracture versus those without. For example, volumetric BMD in those with incident fractures was 232 mg HA/cm3 (95% CI, 213 to 251) and in those without fracture was 317.6 mg HA/cm3 (95% CI, 306 to 329.1). Bone loss occurred in all subjects, but was significantly greater among those with incident fractures. Our data demonstrate that low BMD (by DXA and HRpQCT) and a greater annualized percent decrease in BMD are risk factors for subsequent fracture in men and women with predialysis CKD.

Risk Factors for Subsequent Fracture after Osteoporotic Vertebral Compression Fracture

Percutaneous vertebroplasty (PVP) is considered an effective treatment method for relieving the pain of osteoporotic vertebral compression fractures (VCFs). Although vertebroplasty is relatively safe and has a low complication rate, however, subsequent fracture after vertebroplasty is not uncommon. A possible increase in risk of new VCF after augmentation is of concern, especially in osteoporotic patients. Furthermore, there is no standard parameter for variables such as optimal cement volume, proper cement injection site, and optimal pattern of cement distribution. Factors that may induce subsequent fracture are also uncertain. The purpose of this study was to evaluate the incidence of and risk factors for subsequent fracture after vertebroplasty. Materials and Methods

Survival Times of Patients with a First Hip Fracture With and Without Subsequent Major Long-Bone Fractures

Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated. Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated. Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age <75 years and male sex were risk factors for subsequent fracture. This study found that survival times did not differ significantly between patients with and without subsequent major long-bone fractures after hip fracture. Therefore, all patients with hip fracture, with or without subsequent fractures, need the same robust holistic care. The risks of subsequent fractures should be addressed in patients with hip fracture and should be reduced where possible by education regarding fracture prevention and regular rehabilitation programs. Efforts should be made to decrease the rates of major long-bone fractures and their burdens, even though such fractures have only a minor effect on survival in community-dwelling individuals.

Subsequent Vertebral Fracture After Vertebroplasty

A retrospective review and analysis of consecutive patients who underwent single-level vertebroplasty at our institute between March 2002 and March 2006. To analyze the risk factors for subsequent fractures after vertebroplasty and to predict the postoperative fracture-free time and rate. The effect of bone cement volume injected was also evaluated. Previous studies of subsequent fractures after vertebroplasty showed conflicting conclusions about risk factors. The frequency of refracture also varied, ranging from 12% to 52%. Most new fractures occurred at adjacent levels, with different risk factors identified. No data were available on the effect of injected bone cement volume, and no consensus had been reached as to the optimal cement volume. All enrolled patients were treated with single-level vertebroplasty and followed a standardized postoperative care protocol. Data from medical records and radiographs were collected and analyzed. Variables included patient constitutional factors, radiographic parameters, and volume of injected bone cement. A total of 166 patients (76 men, 90 women) with a mean age of 73.4 years were enrolled in this study. The mean follow-up time was 15.3 months. The overall refracture rate was 38%, with a mean fracture-free interval of 32 months. Both a greater volume of bone cement injected and a greater degree of vertebral height restored contributed significantly to the risk of subsequent adjacent fracture. No risk factor for subsequent remote fracture was identified. A greater volume of bone cement injected was positively correlated with deformity correction after vertebroplasty. Most subsequent fractures occurred at the adjacent level within the first 3 months. Patient preoperative condition did not help predict refracture. Although a greater volume of bone cement injected when performing vertebroplasty contributed to the risk of subsequent adjacent fracture, it resulted in a greater improvement of kyphosis.

A Comparison of Survival Rates for Hip Fracture Patients with or without Subsequent Osteoporotic Vertebral Compression Fractures

Little is known about the effect of a subsequent osteoporotic vertebral compression fracture on the survival rate of patients with a previous hip fracture. In this study, we aimed to compare the survival rates of hip fracture patients with and without subsequent osteoporotic vertebral compression fractures and determine the risk factors associated with subsequent fracture. During 2000-2008, 933 initial hip fracture patients were reviewed and divided into two groups: subsequent fracture group (160 patients) and single hip fracture group (i.e., no subsequent fracture; 773 patients). All information pertaining to their most recent fracture event(s), including mortality causes/rates, were recorded. Differences in mortality rates and hazard ratios (HRs) between the two groups were also analyzed. The 1-year and 1-to-5-year mortality rates were 1.3% and 1.9%, respectively, in the subsequent fracture group, and 4.7% and 1.4%, respectively, in the single hip fracture group, with no significant differences observed. Interestingly, the HR for mortality was significantly higher in the single hip fracture group than in the subsequent fracture group (p < 0.05). The significant risk factors for subsequent fractures were identified as knee osteoarthritis, neurological disease, and an initial hip fracture with intertrochanteric involvement. Our findings indicate that the occurrence of a vertebral compression fracture after an initial hip fracture does not greatly impact patient survival. Conversely, patients presenting with a single hip fracture have a significantly higher mortality-HR, indicating that single hip fracture patients without subsequent fracture should be provided with the same standard of care as patients with subsequent fractures.

New Vertebral Compression Fractures After Prophylactic Vertebroplasty in Osteoporotic Patients

Previous studies have shown the possible efficacy of prophylactic cement injection for nonfractured vertebrae during percutaneous vertebroplasty for compression fractures. The purpose of this study was to investigate risk factors for subsequent fractures after prophylactic percutaneous vertebroplasty. This retrospective study included 116 patients with osteoporotic compression fractures who underwent prophylactic percutaneous vertebroplasty. The patients were monitored with physical examinations and radiographs at 1 day and at 3 and 12 months after percutaneous vertebroplasty, and if back pain recurred. We analyzed the following multiple covariates to determine whether they were associated with recurrence: age, sex, steroid use, and the preoperative number of unhealed or chronic compression fractures. Subsequent fractures in any vertebra occurred within 3 months after the procedure at 26 vertebrae in 21 patients (18.1%), and 36 occurred in 28 patients (24.1%) within 12 months. The occurrence of subsequent fractures within 12 months depended on the preoperative number of unhealed vertebrae: the occurrence rate was 16.9% (11/65) for one vertebra, 27.0% (10/37) for two vertebrae, and 50.0% (7/14) for three or more vertebrae. The incidence of subsequent fractures was significantly higher in patients with three or more fractures than in those with one fracture (p < 0.05). There were no statistically significant differences for the other factors. Patients with three or more fractures tended to have subsequent fractures, despite undergoing prophylactic percutaneous vertebroplasty. However, there was no increased risk of subsequent fractures related to prophylactic percutaneous vertebroplasty.

Male and Non-English-Speaking Patients with Fracture Have Poorer Knowledge of Osteoporosis

Prior fracture is a strong independent risk factor for subsequent fracture. To date, few studies have examined the level of osteoporosis knowledge specifically in the population of patients who have sustained a fracture. This study was designed to assess the knowledge of osteoporosis among patients who sustained a fracture and who were forty years of age or older, as well as to identify what social factors and health and fracture characteristics determine the level of osteoporosis knowledge in this population. Patients who had sustained a fracture and were attending fracture clinics at two Toronto hospitals were identified and invited to fill out a questionnaire during their visit. This questionnaire included questions that could be answered by checking "true," "false," or "don't know" and that were designed to assess the patient's knowledge of osteoporosis. The questionnaire also included questions about the respondent's background. Of 259 patients identified as eligible for the study, 204 (78.8%) agreed to participate. The mean number of correct responses was 16.5 (55%) out of thirty responses. Variables significantly associated with greater numbers of correct responses were female sex, English as a first language, being currently employed, exercising regularly, and having received information from a health-care provider or from a newspaper or magazine. The level of osteoporosis knowledge was fairly low among the surveyed patients, indicating that more education is needed. This study also highlighted certain characteristics (i.e., male sex, English as a second language, being unemployed, and not exercising) that are associated with a lower level of knowledge. Our results can help target certain groups for osteoporosis educational initiatives, especially ethnic groups whose first language is not English, so as to appropriately reduce the risk of future fractures in this high-risk population.