Risk of new vertebral fracture in the year following a fracture

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Lindsay, Robert¹; Silverman, Stuart L.²; Cooper, Cyrus³; Hanley, David A.⁴; Barton, Ian⁵; Broy, Susan B.⁶; Licata, Angelo⁷; Benhamou, Laurent⁸; Geusens, Piet^9,10; Flowers, Kirsten¹¹; Stracke, Hilmar¹²; Seeman, Ego¹³

Risk of new vertebral fracture in the year following a fracture

JAMA. January 17, 2001;285(6):320-323

©2001 American Medical Association. All rights reserved.

Affiliations

¹Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY

²Osteoporosis Medical Center, Cedars Sinai Medical Center, and Greater Los Angeles VA Health System, Los Angeles, Calif

³Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton, England

⁴University of Calgary Health Sciences Centre, Calgary, Alberta

⁵Procter & Gamble Pharmaceuticals, Staines, Middlesex, England

⁶Center for Arthritis and Osteoporosis, Illinois Bone and Joint Institute, Des Plaines

⁷Cleveland Clinic Foundation, Cleveland, Ohio

⁸Centre Hospitalier d’Orleans, Orleans, France

⁹Limburg University Center, Diepenbeek, Belgium

¹⁰University of Maastricht, the Netherlands

¹¹Procter & Gamble Pharmaceuticals, Cincinnati, Ohio

¹²Justus-Liebig University, Giessen, Germany

¹³University of Melbourne, Melbourne, Australia
Abstract

Context: Vertebral fractures significantly increase lifetime risk of future fractures, but risk of further vertebral fractures in the period immediately following a vertebral fracture has not been evaluated.

Objective: To determine the incidence of further vertebral fracture in the year following a vertebral fracture.

Design and Setting: Analysis of data from 4 large 3-year osteoporosis treatment trials conducted at 373 study centers in North America, Europe, Australia, and New Zealand from November 1993 to April 1998.

Subjects: Postmenopausal women who had been randomized to a placebo group and for whom vertebral fracture status was known at entry (n = 2725).

Main Outcome Measure: Occurrence of radiographically identified vertebral fracture during the year following an incident vertebral fracture.

Results: Subjects were a mean age of 74 years and had a mean of 28 years since menopause. The cumulative incidence of new vertebral fractures in the first year was 6.6%. Presence of 1 or more vertebral fractures at baseline increased risk of sustaining a vertebral fracture by 5-fold during the initial year of the study compared with the incidence in subjects without prevalent vertebral fractures at baseline (relative risk [RR], 5.1; 95% confidence interval [CI], 3.1-8.4; P<.001). Among the 381 participants who developed an incident vertebral fracture, the incidence of a new vertebral fracture in the subsequent year was 19.2% (95% CI, 13.6%-24.8%). This risk was also increased in the presence of prevalent vertebral fractures (RR, 9.3; 95% CI, 1.2-71.6; P = .03).

Conclusion: Our data indicate that women who develop a vertebral fracture are at substantial risk for additional fracture within the next year.
Links

DOI: 10.1001/jama.285.3.320

PubMed: 11176842

WoS: 000166324300023

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