Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place van Gehuchten 4, Laeken, 1020, Brussels, Belgium.
Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium.
Osteoporos Int. 2021 Jun;32(6):1093-1101. doi: 10.1007/s00198-020-05772-8. Epub 2021 Jan 7.
Multiple factors increase the risk of an imminent fracture, including a recent fracture, older age, osteoporosis, comorbidities, and the fracture site. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate treatment.
The risk of a recurrent fragility fracture is maximal during the first 2 years following an incident fracture. In this prospective cohort study, we looked at the incidence of recurrent fractures within 2 years after a first incident fracture and we assessed independent clinical risk factors (CRFs) increasing this imminent fracture risk.
A total of 3560 postmenopausal women recruited from 2007 to 2013 were surveyed yearly for the occurrence of fragility fractures. We identified patients who sustained a fracture during the first 2 years following a first incident fragility fracture. We quantified the risk of a new fracture and assessed independent CRFs, associated with an imminent fracture at various sites.
A recent fracture was a significant CRF for an imminent fracture (OR (95% CI): 3.7 (2.4-5.7) [p < 0.0001]). The incidence of an imminent fracture was higher in subjects above 80 years (p < 0.001). Other CRFs highly predictive in a multivariate analysis were osteoporosis diagnosis (p < 0.01), a central fracture as the index fracture (p < 0.01), and the presence of comorbidities (p < 0.05), with likelihood ratios of 1.9, 1.9, and 2.2, respectively. An imminent fracture was better predicted by a central fracture (p < 0.01) than by a major osteoporotic fracture. The hazard ratio was the highest for a central fracture.
In patients with a recent fracture, older age, osteoporosis, comorbidities, and fracture site were associated with an imminent fracture risk. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate and most appropriate treatment.
多种因素会增加骨折风险，包括近期骨折、年龄较大、骨质疏松症、合并症和骨折部位。这些发现可能是开发一种预测即将发生骨折并选择最需要立即治疗的患者的模型的第一步。
本前瞻性队列研究共纳入 3560 名 2007 年至 2013 年招募的绝经后女性，每年调查脆性骨折的发生情况。我们确定了在首次脆性骨折后 2 年内发生骨折的患者。我们量化了新发骨折的风险，并评估了与各部位即将发生骨折相关的独立临床危险因素（CRFs）。
近期骨折是即将发生骨折的显著 CRF（OR（95%CI）：3.7（2.4-5.7）[p<0.0001]）。80 岁以上患者发生即将发生骨折的风险更高（p<0.001）。多变量分析中高度预测的其他 CRFs 包括骨质疏松症诊断（p<0.01）、以中心骨折为索引骨折（p<0.01）和合并症存在（p<0.05），其似然比分别为 1.9、1.9 和 2.2。即将发生骨折的中心骨折（p<0.01）比主要骨质疏松性骨折更好预测。中心骨折的风险比最高。
在近期有骨折的患者中，年龄较大、骨质疏松症、合并症和骨折部位与即将发生骨折的风险相关。这些发现可能是开发一种预测即将发生骨折并选择最需要立即和最合适治疗的患者的模型的第一步。
