Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294, USA.
Osteoporos Int. 2019 Jan;30(1):79-92. doi: 10.1007/s00198-018-4732-1. Epub 2018 Nov 19.
Among 377,561 female Medicare beneficiaries who sustained a fracture, 10% had another fracture within 1 year, 18% within 2 years, and 31% within 5 years. Timely management to reduce risk of subsequent fracture is warranted following all nontraumatic fractures, including nonhip nonvertebral fractures, in older women.
Prior fracture is a strong predictor of subsequent fracture; however, postfracture treatment rates are low. Quantifying imminent (12-24 month) risk of subsequent fracture in older women may clarify the need for early postfracture management.
This retrospective cohort study used Medicare administrative claims data. Women ≥ 65 years who sustained a clinical fracture (clinical vertebral and nonvertebral fracture; index date) and were continuously enrolled for 1-year pre-index and ≥ 1-year (≥ 2 or ≥ 5 years for outcomes at those time points) post-index were included. Cumulative incidence of subsequent fracture was calculated from 30 days post-index to 1, 2, and 5 years post-index. For appendicular fractures, only those requiring hospitalization or surgical repair were counted. Death was considered a competing risk.
Among 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5 years post-index, respectively. Among women age 65-74 years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women ≥ 75 years regardless of initial fracture site (except ankle and tibia/fibula), 7-14% fractured again within 1 year depending on initial fracture site; risk rose to 15-26% within 2 years and 28-42% within 5 years. Risk of subsequent hip fracture exceeded 3% within 5 years in all women studied, except those < 75 years with an initial tibia/fibula or ankle fracture.
We observed a high and early risk of subsequent fracture following a broad array of initial fractures. Timely management with consideration of pharmacotherapy is warranted in older women following all fracture types evaluated.
在 377561 名因骨折而接受治疗的女性医疗保险受益人中，有 10%的人在 1 年内再次骨折，18%的人在 2 年内再次骨折，31%的人在 5 年内再次骨折。对于所有非创伤性骨折，包括非髋部非脊柱骨折，在老年女性中，及时进行管理以降低随后骨折的风险是合理的。
既往骨折是随后骨折的有力预测指标；然而，骨折后的治疗率很低。量化老年女性即将发生（12-24 个月）后续骨折的风险，可以明确早期骨折后管理的必要性。
这是一项使用医疗保险管理索赔数据的回顾性队列研究。纳入≥65 岁的女性患者，她们发生了临床骨折（临床椎体和非椎体骨折；指数日期），并且在指数日期前 1 年和指数日期后至少 1 年（对于这些时间点的结果为至少 2 年或至少 5 年）持续入组。从指数日期后 30 天到 1、2 和 5 年，计算随后骨折的累积发生率。对于四肢骨折，仅计算需要住院或手术修复的骨折。死亡被视为竞争风险。
在 377561 名女性中（2 年和 5 年结果分别为 210621 名和 10969 名），分别有 10%、18%和 31%的女性在指数日期后 1、2 和 5 年时发生后续骨折。在初始临床椎体、髋部、骨盆、股骨或锁骨骨折的 65-74 岁女性和所有≥75 岁的女性中（除了踝关节和胫骨/腓骨骨折），根据初始骨折部位，7-14%的女性在 1 年内再次骨折；风险在 2 年内上升至 15-26%，在 5 年内上升至 28-42%。除了 75 岁以下初始胫骨/腓骨或踝关节骨折的女性外，所有研究女性在 5 年内再次发生髋部骨折的风险均超过 3%。
我们观察到在广泛的初始骨折后，随后骨折的风险很高且发生得很早。对于评估的所有骨折类型，老年女性骨折后及时进行药物治疗管理是合理的。
