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Epidemiological transition to mortality and refracture following an initial fracture


This study sought to redefine the concept of fracture risk that includes refracture and mortality, and to transform the risk into "skeletal age". We analysed data obtained from 3521 women and men aged 60 years and older, whose fracture incidence, mortality, and bone mineral density (BMD) have been monitored since 1989. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%) than in men (22%), but mortality risk was higher in men (41%) than in women (25%). The increased risk of mortality was not only present with an initial fracture, but was accelerated with refractures. Key predictors of post-fracture mortality were male gender (hazard ratio [HR] 2.4; 95% CI, 1.79-3.21), advancing age (HR 1.67; 1.53-1.83), and lower femoral neck BMD (HR 1.16; 1.01-1.33). A 70-year-old man with a fracture is predicted to have a skeletal age of 75. These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions.

Type Journal
ISBN 2050-084X (Electronic) 2050-084X (Linking)
Authors Ho-Le, T. P.; Tran, T. S.; Bliuc, D.; Pham, H. M.; Frost, S. A.; Center, J. R.; Eisman, J. A.; Nguyen, T. V.
Responsible Garvan Author (missing name)
Publisher Name eLife
Published Date 2021-02-28
Published Volume 10
Published Pages e61142
Status Published in-print
DOI 10.7554/eLife.61142
URL link to publisher's version
OpenAccess link to author's accepted manuscript version