title: The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk and mortality.
abstract: BACKGROUND
  We analysed whether a combination of bone- and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture- and fall-prevention guidelines.
  
  
  METHODS
  834 consecutive patients aged ≥50 years with a recent NVF who were included. We compared subgroups of patients according to the presence of bone RFs and/or fall RFs (group 1: only bone RFs; group 2: combination of bone and fall RFs; group 3: only fall RFs; group 4: no additional RFs). Univariable and multivariable Cox regression analyses were performed adjusted for age, sex and baseline fracture location (major or minor).
  
  
  RESULTS
  57 (6.8%) had a subsequent NVF and 29 (3.5%) died within 2-years. Univariable Cox regression analysis showed that patients with the combination of bone and fall RFs had a 99% higher risk in subsequent fracture risk compared to all others (Hazard Ratio (HR) 1.99; 95% Confidence Interval (CI) 1.18-3.36) Multivariable analyses this was borderline not significant (HR 1.70; 95% CI: 0.99-2.93). No significant differences in mortality were found between the groups.
  
  
  CONCLUSIONS
  Evaluation of fall RFs contributes to identifying patients with bone RFs at highest immediate risk of subsequent NVF in spite of guideline-based treatment. It should be further studied whether earlier and immediate prevention following a NVF can decrease fracture risk in patients with a combination of bone and fall RFs.
authors.affiliation: Department of Trauma Surgery, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), P, Debyelaan 25, P,O, Box 5800, Maastricht, 6202 AZ, The Netherlands. k.huntjens@maastrichtuniversity.nl.
authors.forename: Kirsten M B
authors.initials: KM
authors.lastname: Huntjens
authors.forename: Tineke A C M
authors.initials: TA
authors.lastname: van Geel
authors.forename: Svenhjalmar
authors.initials: S
authors.lastname: van Helden
authors.forename: Joop
authors.initials: J
authors.lastname: van den Bergh
authors.forename: Paul
authors.initials: P
authors.lastname: Willems
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Piet P
authors.initials: PP
authors.lastname: Geusens
authors.forename: Peter R G
authors.initials: PR
authors.lastname: Brink
mesh_terms: D000058:Accidental Falls / Q000401:mortality* / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
references.citation: Ann Rheum Dis. 2009 Jan;68(1):99-102
references.pmid: 18677009
references.citation: Osteoporos Int. 2011 Jul;22(7):2129-35
references.pmid: 21052640
references.citation: Injury. 2011 Sep;42 Suppl 4:S39-43
references.pmid: 21939802
references.citation: N Engl J Med. 2009 Aug 20;361(8):756-65
references.pmid: 19671655
references.citation: J Clin Endocrinol Metab. 2011 Apr;96(4):1006-14
references.pmid: 21289270
references.citation: J Bone Miner Res. 2012 Oct;27(10):2039-46
references.pmid: 22836222
references.citation: Bone. 2011 Sep;49(3):493-8
references.pmid: 21605715
references.citation: Osteoporos Int. 2005 Oct;16(10):1291-8
references.pmid: 15986101
references.citation: J Bone Joint Surg Am. 2008 Feb;90(2):241-8
references.pmid: 18245581
references.citation: Osteoporos Int. 2001 Dec;12 Suppl 3:S11-6
references.pmid: 11846336
references.citation: Osteoporos Int. 2004 Mar;15(3):175-9
references.pmid: 14691617
references.citation: Osteoporos Int. 2010 Dec;21(12):2075-82
references.pmid: 20162259
references.citation: J Bone Miner Res. 2000 Apr;15(4):721-39
references.pmid: 10780864
references.citation: Osteoporos Int. 2006;17(3):348-54
references.pmid: 16378167
references.citation: Maturitas. 2009 Feb 20;62(2):105-8
references.pmid: 19135323
references.citation: JAMA. 2007 Jan 24;297(4):387-94
references.pmid: 17244835
references.citation: Osteoporos Int. 2004 Jan;15(1):38-42
references.pmid: 14593451
references.citation: JAMA. 2009 Feb 4;301(5):513-21
references.pmid: 19190316
references.citation: N Engl J Med. 2007 May 3;356(18):1809-22
references.pmid: 17476007
references.citation: J Clin Endocrinol Metab. 2000 Nov;85(11):4118-24
references.pmid: 11095442
references.citation: Lancet. 1999 Mar 13;353(9156):878-82
references.pmid: 10093980
references.citation: Curr Osteoporos Rep. 2011 Sep;9(3):116-21
references.pmid: 21655932
references.citation: JAMA. 2001 Jan 17;285(3):320-3
references.pmid: 11176842
references.citation: Osteoporos Int. 2000;11(1):83-91
references.pmid: 10663363
references.citation: J Bone Miner Res. 2009 Jul;24(7):1299-307
references.pmid: 19257816