Progressively increasing fracture risk with advancing age after initial incident fragility fracture: The Tromsø Study

Authors

  • Luai Awad Ahmed,

    Corresponding author
    1. Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
    • Address correspondence to: Luai Awad Ahmed, Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. E-mail: luai.ahmed@uit.no

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  • Jacqueline R Center,

    1. Osteoporosis & Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia
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  • Åshild Bjørnerem,

    1. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
    2. Department of Obstetric and Gynecology, University Hospital of North Norway, Tromsø, Norway
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  • Dana Bluic,

    1. Osteoporosis & Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia
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  • Ragnar M Joakimsen,

    1. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
    2. Medical Clinic, University Hospital of North Norway, Tromsø, Norway
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  • Lone Jørgensen,

    1. Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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  • Haakon E Meyer,

    1. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
    2. Department of Community Medicine, Institute of Health and Society, University of Oslo, Norway
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  • Nguyen D Nguyen,

    1. Osteoporosis & Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia
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  • Tuan V Nguyen,

    1. Osteoporosis & Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia
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  • Tone K Omsland,

    1. Medical Clinic, University Hospital of North Norway, Tromsø, Norway
    2. Department of Public Health and Primary Health Care, University of Bergen, Norway
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  • Jan Størmer,

    1. Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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  • Grethe S Tell,

    1. Department of Community Medicine, Institute of Health and Society, University of Oslo, Norway
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  • Tineke ACM van Geel,

    1. Department of General Practice, Maastricht University, Maastricht, The Netherlands
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  • John A Eisman,

    1. Osteoporosis & Bone Biology Program, Garvan Institute of Medical Research, Sydney, Australia
    2. Department of Endocrinology, St Vincent's Hospital, Sydney, Australia
    3. St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
    4. School of Medicine, University of Notre Dame, Sydney, Australia
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  • Nina Emaus

    1. Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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ABSTRACT

The risk of subsequent fracture is increased after initial fractures; however, proper understanding of its magnitude is lacking. This population-based study examines the subsequent fracture risk in women and men by age and type of initial incident fracture. All incident nonvertebral fractures between 1994 and 2009 were registered in 27,158 participants in the Tromsø Study, Norway. The analysis included 3108 subjects with an initial incident fracture after the age of 49 years. Subsequent fracture (n = 664) risk was expressed as rate ratios (RR) and absolute proportions irrespective of death. The rates of both initial and subsequent fractures increased with age, the latter with the steepest curve. Compared with initial incident fracture rate of 30.8 per 1000 in women and 12.9 per 1000 in men, the overall age-adjusted RR of subsequent fracture was 1.3 (95% CI, 1.2–1.5) in women, and 2.0 (95% CI, 1.6–2.4) in men. Although the RRs decreased with age, the absolute proportions of those with initial fracture who suffered a subsequent fracture increased with age; from 9% to 30% in women and from 10% to 26% in men, between the age groups 50–59 to 80+ years. The type of subsequent fracture varied by age from mostly minor fractures in the youngest to hip or other major fractures in the oldest age groups, irrespective of type and severity of initial fracture. In women and men, 45% and 38% of the subsequent hip or other major fractures, respectively, were preceded by initial minor fractures. The risk of subsequent fracture is high in all age groups. At older age, severe subsequent fracture types follow both clinically severe and minor initial incident fractures. Any fragility fracture in the elderly reflects the need for specific osteoporosis management to reduce further fracture risk. © 2013 American Society for Bone and Mineral Research.

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