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

Summary:Fractures after the age of 50 are frequently observedin Denmark, and many of these may be osteoporotic. Thisstudy examined the incidence of all and subsequent fractures ina 10-year period from 2001 to 2011. The incidence of subsequentfractures was high, especially following hip fracture.Introduction: The purpose of this study is to examine patternsof subsequent fractures and mortality rates over a 10-yearperiod in patients already suffering from fracture.Methods: The study was designed as a nationwide, registerbasedfollow-up study. Patients were included if diagnosedwith 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 andT12.x) between January 1st, 2001 and December 31st, 2001and if older than 50 years at time of fracture. The patients wereinvestigated for future subsequent fractures from January 1st,2002 to December 31st, 2011.Results: In this study, we demonstrated that patients withfractures (especially hip fractures) have a high risk ofsubsequent fractures, especially hip fracture. Other fractures,which are not commonly considered as osteoporotic fractures,such as lower leg, were frequently observed in the 10 yearsfollowing index fracture. The cumulative incidence proportion(CIP) of subsequent fractures during the 10-year followupperiod was high for all recurrent fractures (9–46 %). Subsequenthip fracture, regardless of index fracture, had thehighest CIP across the study period, ranging from 9 to 40 %.Appendicular fractures were often followed by a recurrentfracture, or subsequent fractures at a more proximal locationin the same limb, i.e. forearm fractures were followed byhumerus fractures. These results have not been previouslydemonstrated to this extent, and according to our knowledge,no previous studies have estimated cumulative 10-year subsequentfracture incidences for any non-hip fractures.Conclusion: Patients suffering a fracture (and especially a hipfracture) have a high incidence of subsequent fracture. Fracturesafter the age of 50 may be considered an early warning ofincreased risk for future fractures in many patients.