Risk for Subsequent Osteoporotic Fracture Elevated in Men vs Women

Hip Fracture
Hip Fracture
The risk for subsequent osteoporotic fracture was elevated for both sexes over a 25-year follow-up period.

The following article is part of conference coverage from the 2018 American Society for Bone and Mineral Research (ASBMR) Annual Meeting in Montreal, Canada. Rheumatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts on bone health. Check back for the latest news from ASBMR 2018 .

The risk for subsequent osteoporotic fracture is elevated in both men and women over a 25-year follow-up period, according to data presented at the American Society for Bone and Mineral Research 2018 Annual Meeting, held September 28 through October 1, 2018, in Montreal, Quebec, Canada. However, the risk for subsequent fracture was higher among men, particularly during the first 3 years.

Investigators performed a matched historical cohort study, including 17,721 men and 57,783 women older than 50 years who sustained an index major osteoporotic fracture between 1989 and 2006. They compared rates of subsequent fracture with age- and sex-matched controls (n=165,965) until 2016. A total of 29,694 index cases of major osteoporotic fracture were identified, including 11,028 wrist fractures, 9313 hip fractures, 5799 humerus fractures, and 3554 spine fractures.

The annual crude rate of subsequent major osteoporotic fracture was 18.5 per 1000 person-years in men (95% CI, 17.3-19.8) and 29.6 per 1000 person-years in women (95% CI, 28.8-30.4). In addition, the rate ratios across all follow-up years were 2.5 (95% CI, 2.3-2.7) in men and 1.6 (95% CI, 1.6-1.7) in women compared with controls.

The cumulative incidence of subsequent major osteoporotic fracture through 25 years was higher among participants with a prior fracture vs controls for men and women in all age groups, except for patients older than 80 years. The researchers note that this relationship was reversed in patients older than 80 years due to competing mortality.

Hazard ratios (HRs) for subsequent fracture were higher among men than women, particularly in the first year following the index fracture (HR, 3.3; 95% CI, 2.6-4.1 in men; HR, 1.8; 95% CI, 1.7-2.0 in women) and remained high for men during the first 3 years. The risk for subsequent fracture declined over time, but remained elevated ≥15 years after the index fracture in both men (HR, 1.8; 95% CI, 1.4-2.4) and women (HR, 1.5; 95% CI, 1.3-1.6).

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“These results underscore the importance of timely recognition of fracture events, especially in men, a population in whom secondary prevention is vastly under-implemented,” the authors concluded.

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Morin SN, Yan L, Lix LM, Leslie WD. Changes at the risk of subsequent major osteoporotic fractures over time in men and women: a population-based observational study with 25-year follow up. Presented at: ASBMR 2018 Annual Meeting; September 28-October 1, 2018; Montreal, Canada. Abstract 1038.