title: Previous fractures at multiple sites increase the risk for subsequent fractures: the Global Longitudinal Study of Osteoporosis in Women.
abstract: Previous fractures of the hip, spine, or wrist are well-recognized predictors of future fracture, but the role of other fracture sites is less clear. We sought to assess the relationship between prior fracture at 10 skeletal locations and incident fracture. The Global Longitudinal Study of Osteoporosis in Women (GLOW) is an observational cohort study being conducted in 17 physician practices in 10 countries. Women aged ≥55 years answered questionnaires at baseline and at 1 and/or 2 years (fractures in previous year). Of 60,393 women enrolled, follow-up data were available for 51,762. Of these, 17.6%, 4.0%, and 1.6% had suffered 1, 2, or ≥3 fractures, respectively, since age 45 years. During the first 2 years of follow-up, 3149 women suffered 3683 incident fractures. Compared with women with no previous fractures, women with 1, 2, or ≥3 prior fractures were 1.8-, 3.0-, and 4.8-fold more likely to have any incident fracture; those with ≥3 prior fractures were 9.1-fold more likely to sustain a new vertebral fracture. Nine of 10 prior fracture locations were associated with an incident fracture. The strongest predictors of incident spine and hip fractures were prior spine fracture (hazard ratio [HR] = 7.3) and hip (HR = 3.5). Prior rib fractures were associated with a 2.3-fold risk of subsequent vertebral fracture, and previous upper leg fracture predicted a 2.2-fold increased risk of hip fracture. Women with a history of ankle fracture were at 1.8-fold risk of future fracture of a weight-bearing bone. Our findings suggest that a broad range of prior fracture sites are associated with an increased risk of incident fractures, with important implications for clinical assessments and risk model development.
authors: Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA 01605, USA. gehlbach@schoolph.umass.edu
authors: Stephen
authors: S
authors: Gehlbach
authors: Kenneth G
authors: KG
authors: Saag
authors: Jonathan D
authors: JD
authors: Adachi
authors: Fred H
authors: FH
authors: Hooven
authors: Julie
authors: J
authors: Flahive
authors: Steven
authors: S
authors: Boonen
authors: Roland D
authors: RD
authors: Chapurlat
authors: Juliet E
authors: JE
authors: Compston
authors: Cyrus
authors: C
authors: Cooper
authors: Adolfo
authors: A
authors: Díez-Perez
authors: Susan L
authors: SL
authors: Greenspan
authors: Andrea Z
authors: AZ
authors: LaCroix
authors: J Coen
authors: JC
authors: Netelenbos
authors: Johannes
authors: J
authors: Pfeilschifter
authors: Maurizio
authors: M
authors: Rossini
authors: Christian
authors: C
authors: Roux
authors: Philip N
authors: PN
authors: Sambrook
authors: Stuart
authors: S
authors: Silverman
authors: Ethel S
authors: ES
authors: Siris
authors: Nelson B
authors: NB
authors: Watts
authors: Robert
authors: R
authors: Lindsay
mesh_terms: D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D012307:Risk Factors; D011795:Surveys and Questionnaires