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The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000–2010

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Abstract

Summary

The risk of a subsequent major or any fracture after a hip fracture and secular trends herein were examined. Within 1 year, 2.7 and 8.4 % of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5 % after 5 years. Subsequent fracture rates increased during the study period both for major and any (non-hip) fracture.

Introduction

Hip fractures are associated with subsequent fractures, particularly in the year following initial fracture. Age-adjusted hip fracture rates have stabilised in many developed countries, but secular trends in subsequent fracture remain poorly documented. We thus evaluated secular trends (2000–2010) and determinants for the risk of a subsequent major (humerus, vertebral, or forearm) and any (non-hip) fracture after hip fracture.

Methods

Patients ≥50 years with a hip fracture between 2000 and 2010 were extracted from the UK Clinical Practice Research Datalink (n = 30,516). Incidence rates, cumulative incidence probabilities, and adjusted hazard ratios (aHRs) were calculated.

Results

Within 1 year following hip fracture, 2.7 and 8.4 % of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5 % after 5 years, respectively. The most important risk factors for a subsequent major fracture within 1 year were the female gender [aHR 1.90, 95 % confidence interval (CI) 1.51–2.40] and a history of secondary osteoporosis (aHR 1.54, 95 % CI 1.17–2.02). The annual risk increased during the study period for both subsequent major (2009–2010 vs. 2000–2002: aHR 1.44, 95 % CI 1.12–1.83) and any (non-hip) facture (2009–2010 vs. 2000–2002: aHR 1.80, 95 % CI 1.58–2.06).

Conclusion

The risk of sustaining a major or any (non-hip) fracture after hip fracture is small in the first year. However, given the recent rise in secondary fracture rates and the substantial risk of subsequent fracture in the longer term, fracture prevention is clearly indicated for patients who have sustained a hip fracture.

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Acknowledgment

This study was supported by a research grant from The Netherlands Organisation for Health Research and Development (ZonMw; grant number 113101007) and the UK National Osteoporosis Society. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

Conflicts of interest

This work was supported by a grant from The Netherlands Organisation for Health Research and Development. The Division of Pharmacoepidemiology & Clinical Pharmacology employing FV, CK, and TPS has received unrestricted funding from the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the Royal Dutch Pharmacists Association (KNMP), the private–public-funded Top Institute Pharma (http://www.tipharma.nl) including co-funding from universities, government, and industry, the EU Innovative Medicines Initiative (IMI), the EU 7th Framework Program (FP7), the Dutch Ministry of Health and industry (including GlaxoSmithKline, Pfizer, etc.). HGML is a researcher at The WHO Collaborating Centre for Pharmaceutical Policy & Regulation, which receives no direct funding or donations from private parties, including pharma industry. Research funding from public–private partnerships, e.g., IMI, TI Pharma (http://www.tipharma.nl) is accepted under the condition that no company-specific product or company-related study is conducted. The centre has received unrestricted research funding from public sources, e.g., the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch Health Care Insurance Board (CVZ), the EU 7th Framework Program (FP7), the Dutch Medicines Evaluation Board (MEB), and the Dutch Ministry of Health. The authors DGS, PE, NS, PMJW, and NCH report no conflict of interest.

Author information

Authors and Affiliations

  1. Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

    D. Gibson-Smith, C. Klop, H. G. M. Leufkens, T. P. van Staa & F. de Vries

  2. Department of Psychiatry/EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands

    D. Gibson-Smith

  3. Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, The Netherlands

    P. J. M. Elders

  4. Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands

    P. M. J. Welsing

  5. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands

    P. M. J. Welsing

  6. Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands

    N. van Schoor

  7. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK

    N. C. Harvey & F. de Vries

  8. NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK

    N. C. Harvey

  9. Department of Clinical Pharmacology and Toxicology, University Medical Centre Maastricht, Maastricht, The Netherlands

    F. de Vries

  10. Maastricht University/CAPHRI, Maastricht, The Netherlands

    F. de Vries

  11. Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands

    F. de Vries

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  1. D. Gibson-Smith
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  2. C. Klop
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  3. P. J. M. Elders
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  4. P. M. J. Welsing
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  6. H. G. M. Leufkens
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  7. N. C. Harvey
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  8. T. P. van Staa
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  9. F. de Vries
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Corresponding author

Correspondence to F. de Vries.

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Gibson-Smith, D., Klop, C., Elders, P.J.M. et al. The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000–2010. Osteoporos Int 25, 2555–2563 (2014). https://doi.org/10.1007/s00198-014-2799-x

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  • DOI: https://doi.org/10.1007/s00198-014-2799-x

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