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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/11549

Title: Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture
Authors: Huntjens, K. M. B.
Kosar, S.
van Geel, T. A. C. M.
GEUSENS, Piet
Willems, P.
Kessels, A.
Winkens, B.
Brink, P.
van Helden, S.
Issue Date: 2010
Publisher: SPRINGER LONDON LTD
Citation: OSTEOPOROSIS INTERNATIONAL, 21 (12). p. 2075-2082
Abstract: The absolute 5-year risk of subsequent non-vertebral fractures (NVFs) in 1,921 patients presenting with a NVF was 17.6% and of mortality was 32.3%. These risks were highest within the first year, indicating the need to study which reversible factors can be targeted to immediately minimise subsequent fracture risk and mortality. Introduction NVFs are the most frequent clinical fractures in patients presenting at the emergency unit because of a clinical fracture. The aim of the study was to determine the 5-year absolute risk (AR) of subsequent NVF and mortality in patients at the time they present with a NVF. Methods Between 1999 and 2001, 1,921 consecutive patients 50+years from a level 1 trauma centre were included. All NVFs were confirmed on radiograph reports, and mortality was checked in the national obituary database. Available potential risk factors for a subsequent NVF and mortality (age, sex and baseline fracture location: major-hip, pelvis, multiple ribs, proximal tibia/humerus and distal femur; minor-all others) were expressed as hazard ratios (HR) with 95% confidence intervals (CI) using multivariable Cox regression analysis. Results The AR for a subsequent NVF was 17.6% and was related to age (HR per decade, 1.44; 95% CI, 1.29-1.60). The AR for mortality was 32.3% and was related to age (HR per decade, 2.59; 95% CI, 2.37-2.84), male sex (HR, 1.74; 95% CI, 1.44-2.10), major fracture at baseline (HR, 5.56; 95% CI, 3.48-8.88; not constant over time) and subsequent fracture (HR, 1.65; 95% CI, 1.33-2.05). The highest risks were found within the first year (NVFs, 6.4%; mortality, 12.2%) and were related to age and, in addition, to baseline fracture location for mortality. Conclusions Within 5 years after an initial NVF, nearly one in five patients sustained a subsequent NVF and one in three died. One third of subsequent NVFs and mortality occurred within 1 year, indicating the need to study which reversible factors can be targeted to immediately prevent subsequent fractures and mortality.
Notes: [Huntjens, K. M. B.; Kosar, S.; Brink, P.; van Helden, S.] Maastricht Univ, Med Ctr, Dept Trauma Surg, NL-6202 AZ Maastricht, Netherlands. [Huntjens, K. M. B.; Kosar, S.; van Geel, T. A. C. M.; Winkens, B.; Brink, P.; van Helden, S.] Sch Publ Hlth & Primary Care CAPHRI, Maastricht, Netherlands. [van Geel, T. A. C. M.] Maastricht Univ, Med Ctr, Dept Gen Practice, NL-6200 MD Maastricht, Netherlands. [Geusens, P. P.] Maastricht Univ, Med Ctr, Dept Internal Med Rheumatol, NL-6200 MD Maastricht, Netherlands. [Geusens, P. P.] Univ Hasselt, Biomed Res Inst, Hasselt, Belgium. [Kessels, A.] KEMTA Klin Epidemiol & Med Technol Assessment, Maastricht, Netherlands. [Willems, P.] Maastricht Univ, Med Ctr, Dept Othopaed Surg, NL-6202 AZ Maastricht, Netherlands. [Winkens, B.] Maastricht Univ, Med Ctr, Dept Methodol & Stat, NL-6202 AZ Maastricht, Netherlands. k.huntjens@ah.unimaas.nl
URI: http://hdl.handle.net/1942/11549
DOI: 10.1007/s00198-010-1178-5
ISI #: 000285306900012
ISSN: 0937-941X
Category: A1
Type: Journal Contribution
Validation: ecoom, 2012
Appears in Collections: Research publications

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