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29-11-2011 | Bone health | Article

Fracture at multiple sites predicts future fracture risk


Free abstract

MedWire News: History of fracture at a broad range of bone sites is associated with an increased risk for subsequent fractures, research shows.

Expanding the clinical significance of previous fractures to more bone locations is important for assessing patient risk, and should be included in the development of future risk models, remark Stephen Gehlbach (University of Massachusetts Medical School, Boston, USA) and colleagues.

Past fractures at the hip, spine, and wrist are known predictors for future fractures in postmenopausal women, but the predictive value of fracture at other sites is less clear, they say.

Using data from a large longitudinal study of women with osteoporosis, the researchers assessed the relationship between previous fractures at 10 skeletal locations and incident fractures.

Of the 51,762 women, aged over 55 years, included in the analysis17.6%, 4.0%, and 1.6% had one, two, or three or more fractures, respectively, since the age of 45. The results, published in the Journal of Bone and Mineral Research, show that women with one previous fracture were 1.8 times more likely to have any incident fracture than women without previous fractures.

For those women with two or three or more fractures, the risk for a new fracture was 3.0-fold and 4.8-fold greater, respectively, than women without a previous fracture. In addition, women with three or more fractures were over nine times more likely to suffer a new vertebral fracture than those with no history of fracture.

Of the 10 skeletal locations, nine sites were associated with an increased risk for incident fracture, with prior spine and hip fractures being the strongest predictors for future fracture risk.

The study demonstrated for the first time that rib and ankle fracture significantly predict the risk for further fracture. Wrist, upper arm, and upper leg fractures were also associated with an increased risk for fracture.

The data suggest that a "broader range of previous fracture sites than is commonly considered is associated with future fractures, and that occurrence of multiple past fractures substantially increases subsequent risk," state Gehlbach and colleagues.

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