Quantify Research, Stockholm, Sweden.
Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research, Lund University, Malmö, Sweden.
Osteoporos Int. 2019 Mar;30(3):601-609. doi: 10.1007/s00198-019-04852-8. Epub 2019 Jan 24.
This 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.
This 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.
Retrospective, 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.
Two 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).
Our 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.
本研究旨在确定首次骨折后 1 年和 2 年内发生后续骨折的即刻风险，并评估与后续骨折相关的独立因素。
从瑞典国家登记处确定了≥50 岁有脆性骨折的女性回顾性、观察性队列研究。计算了指数骨折时的临床/人口统计学特征和指数骨折后 12 个月和 24 个月的累积骨折发生率。使用多变量回归分析确定后续骨折的危险因素。
共纳入 242108 名女性（平均[标准差]年龄 74[12.5]岁）。12 个月时的累积后续骨折发生率为 7.1%（95%置信区间[CI]，6.9%-7.2%），24 个月时为 12.0%（95%CI，11.8%-12.1%）。在第一个月内发生后续骨折的比例最高（15 例/1000 患者年），在 4 至 24 个月之间保持稳定（5 例/1000 患者年）。年龄较高是发生后续骨折的独立危险因素（24 个月时，亚分布危险比[HR]，3.07；p<0.001，80-89 岁女性[参考 50-59 岁]）。椎体骨折是后续骨折的一个强有力的独立危险因素（12 个月时，亚分布 HR，2.72 与髋部骨折相比；p<0.001；24 个月时 HR，2.23；p<0.001）。
我们的研究结果强调了绝经后妇女在发生任何脆性骨折后应迅速干预。脆性骨折的发生为医疗保健系统提供了一个独特的机会，以进行干预，降低随后骨折的风险增加。
