title: Timing and risk factors for clinical fractures among postmenopausal women: a 5-year prospective study.
abstract: BACKGROUND
  Many risk factors for fractures have been documented, including low bone-mineral density (BMD) and a history of fractures. However, little is known about the short-term absolute risk (AR) of fractures and the timing of clinical fractures. Therefore, we assessed the risk and timing of incident clinical fractures, expressed as 5-year AR, in postmenopausal women.
  
  
  METHODS
  In total, 10 general practice centres participated in this population-based prospective study. Five years after a baseline assessment, which included clinical risk factor evaluation and BMD measurement, 759 postmenopausal women aged between 50 and 80 years, were re-examined, including undergoing an evaluation of clinical fractures after menopause. Risk factors for incident fractures at baseline that were significant in univariate analyses were included in a multivariate Cox survival regression analysis. The significant determinants were used to construct algorithms.
  
  
  RESULTS
  In the total group, 12.5% (95% confidence interval (CI) 10.1-14.9) of the women experienced a new clinical fracture. A previous clinical fracture after menopause and a low BMD (T-score <-1.0) were retained as significant predictors with significant interaction. Women with a recent previous fracture (during the past 5 years) had an AR of 50.1% (95% CI 42.0-58.1) versus 21.2% (95% CI 20.7-21.6) if the previous fracture had occurred earlier. In women without a fracture history, the AR was 13.8% (95% CI 10.9-16.6) if BMD was low and 7.0% (95% CI 5.5-8.5) if BMD was normal.
  
  
  CONCLUSIONS
  In postmenopausal women, clinical fractures cluster in time. One in two women with a recent clinical fracture had a new clinical fracture within 5 years, regardless of BMD. The 5-year AR for a first clinical fracture was much lower and depended on BMD.
authors.affiliation: Care and Public Health Research Institute, Department of General Practice, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. t.vangeel@hag.unimaas.nl
authors.forename: Antonia C M
authors.initials: AC
authors.lastname: van Geel
authors.forename: Piet P
authors.initials: PP
authors.lastname: Geusens
authors.forename: Ivo F
authors.initials: IF
authors.lastname: Nagtzaam
authors.forename: Cyril M J R
authors.initials: CM
authors.lastname: Schreurs
authors.forename: Danny J M
authors.initials: DJ
authors.lastname: van der Voort
authors.forename: Paula E L M
authors.initials: PE
authors.lastname: Rinkens
authors.forename: Arnold D M
authors.initials: AD
authors.lastname: Kester
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000368:Aged; D015519:Bone Density; D002118:Calcium / Q000008:administration & dosage; D003069:Coffee; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D017698:Postmenopause; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D003069:Coffee; D002118:Calcium