title: Risk factors for clinical fractures among postmenopausal women: a 10-year prospective study.
abstract: OBJECTIVE
  Only scarce data are available on the long-term absolute risk (AR) of all clinical fractures, taking into account the time when they occurred. Therefore, we assessed during a 10-year follow-up the risk factors associated with the occurrence of any first or second clinical fracture.
  
  
  METHODS
  This was a population-based study in 10 general practice centres. The sample comprised 2372 postmenopausal women, aged between 50 and 80 years at baseline, who completed a questionnaire about the incidence of radiographically confirmed fractures and fracture risks, analysed by multiple Cox regression.
  
  
  METHODS
  AR for any clinical fracture.
  
  
  RESULTS
  During the 10-year follow-up, 380 women (16%) had a fracture. A first fracture occurred in 267 women (11%). Osteoporosis at the lumbar spine (T-score <-2.5; hazard ratio (HR) 1.8, 95% confidence interval (CI) 1.4-2.3) and age over 60 years (HR1.4, 95% CI 1.1-1.8) were the only risk factors retained in the Cox analysis. The AR in the lowest-risk group was 10%, and it was 23% in the highest-risk group. A second fracture occurred in 113 women during follow-up (5%). The time when a fracture occurred was the only risk factor retained in the Cox analysis. The AR for a second fracture was 41% in the five years after any first fracture before baseline and 25% if the first fracture had occurred earlier (HR 1.8, 95% CI 1.3-2.7).
  
  
  CONCLUSIONS
  In postmenopausal women, over a 10-year follow-up, the AR of a second clinical fracture is highest in the five years after any first clinical fracture. The AR for a first clinical fracture is lower and depends on osteoporosis and age.
authors.affiliation: Department of General Practice, Maastricht University, The Netherlands. t.vangeel@hag.unimaas.nl
authors.forename: Tineke A C M
authors.initials: TA
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: Danny J M
authors.initials: DJ
authors.lastname: van der Voort
authors.forename: Cyril M J R
authors.initials: CM
authors.lastname: Schreurs
authors.forename: Paula E L M
authors.initials: PE
authors.lastname: Rinkens
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Dinant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology*; D017698:Postmenopause; D011446:Prospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016387:Women's Health