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Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective

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Abstract

Summary

Fractures after the age of 50 are frequently observed in Denmark, and many of these may be osteoporotic. This study examined the incidence of all and subsequent fractures in a 10-year period from 2001 to 2011. The incidence of subsequent fractures was high, especially following hip fracture.

Introduction

The purpose of this study is to examine patterns of subsequent fractures and mortality rates over a 10-year period in patients already suffering from fracture.

Methods

The study was designed as a nationwide, register-based follow-up study. Patients were included if diagnosed with an index fracture (ICD-10 codes: S22.x, S32.x, S42.x, S52.x, S62.x, S72.x, S82.x, S92.x, T02.x, T08.x, T10.x and T12.x) between January 1st, 2001 and December 31st, 2001 and if older than 50 years at time of fracture. The patients were investigated for future subsequent fractures from January 1st, 2002 to December 31st, 2011.

Results

In this study, we demonstrated that patients with fractures (especially hip fractures) have a high risk of subsequent fractures, especially hip fracture. Other fractures, which are not commonly considered as osteoporotic fractures, such as lower leg, were frequently observed in the 10 years following index fracture. The cumulative incidence proportion (CIP) of subsequent fractures during the 10-year follow-up period was high for all recurrent fractures (9–46 %). Subsequent hip fracture, regardless of index fracture, had the highest CIP across the study period, ranging from 9 to 40 %. Appendicular fractures were often followed by a recurrent fracture, or subsequent fractures at a more proximal location in the same limb, i.e. forearm fractures were followed by humerus fractures. These results have not been previously demonstrated to this extent, and according to our knowledge, no previous studies have estimated cumulative 10-year subsequent fracture incidences for any non-hip fractures.

Conclusion

Patients suffering a fracture (and especially a hip fracture) have a high incidence of subsequent fracture. Fractures after the age of 50 may be considered an early warning of increased risk for future fractures in many patients.

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Funding

This study was supported by a grant from the Danish Bone Society.

Conflicts of interest

LH has received research grants from MSD Danmark ApS and honoraria from Eli Lilly and MSD Danmark.

KDP and SAE have no conflicts of interest.

BLL has received research grants from Eli Lilly and Axellus; served on advisory boards for Eli Lilly, Merck, Sharp & Dohme and Amgen and received honoraria from Eli Lilly, Merck, Sharp & Dohme and Amgen.

PE is an advisory board member of Eli Lilly, MSD and Amgen and has received lecture fees from Eli Lilly, Amgen and GlaxoSmithKline.

KB reports serving on the board for Osteologix, Servier, Amgen and Novartis; receiving payment for expert testimony on a patent for strontium maleate in the USA; consulting fees from Osteologix; lecture fees from Servier, Amgen, GlaxoSmithKline and Novartis and payment for travel accommodation from Amgen, Eli Lilly, Servier and Novartis.

KB further reports receiving grant support to his institution, Odense University Hospital, from Merck, Sharp & Dohme and Novartis and investigator payments from Merck, Sharp & Dohme, Osteologix, Servier, Amgen, Natural Product Sciences Pharmaceuticals and Eli Lilly.

BA received grants from or conducted trials for Novartis, Nycomed/Takeda and Amgen and served as an advisory board member for Nycomed/Takeda, Merck and Amgen.

JEBJ received honoraria from and is an advisory board member for Eli Lilly, Merck, Sharp & Dohme and Amgen.

TH received speaker’s honorarium from Amgen.

PV received unrestricted research grants from Servier and MSD and travel grants from Amgen, MSD, Eli Lilly, Novartis and Servier.

Author information

Authors and Affiliations

  1. Danish Center for Healthcare Improvements, Department of Business and Management and Department of Health Science and Technology, Aalborg University, Fibigerstraede 11, 9220, Aalborg East, Denmark

    L. Hansen & K. D. Petersen

  2. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

    S. A. Eriksen & P. Vestergaard

  3. Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, Aarhus, Denmark

    B. L. Langdahl & T. Harsløf

  4. Department of Cardiology, Nephrology and Endocrinology, Copenhagen University Hospital Nordsjaelland, Hillerød, Denmark

    P. A. Eiken

  5. Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    P. A. Eiken

  6. Research Centre for Ageing and Osteoporosis, Glostrup Hospital, and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    K. Brixen & B. Abrahamsen

  7. Department of Endocrinology, Hvidovre University Hospital, Copenhagen, Denmark

    J.-E. B. Jensen

  8. Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

    P. Vestergaard

Authors
  1. L. Hansen
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  2. K. D. Petersen
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  3. S. A. Eriksen
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  4. B. L. Langdahl
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  5. P. A. Eiken
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  6. K. Brixen
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  7. B. Abrahamsen
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  8. J.-E. B. Jensen
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  9. T. Harsløf
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  10. P. Vestergaard
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Corresponding author

Correspondence to L. Hansen.

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Hansen, L., Petersen, K.D., Eriksen, S.A. et al. Subsequent fracture rates in a nationwide population-based cohort study with a 10-year perspective. Osteoporos Int 26, 513–519 (2015). https://doi.org/10.1007/s00198-014-2875-2

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  • DOI: https://doi.org/10.1007/s00198-014-2875-2

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