title: The risk of major and any (non-hip) fragility fracture after hip fracture in the United Kingdom: 2000-2010.
abstract: The risk of a subsequent major or any fracture after a hip fracture and secular trends herein were examined. Within 1 year, 2.7 and 8.4% of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5% after 5 years. Subsequent fracture rates increased during the study period both for major and any (non-hip) fracture.
  
  
  BACKGROUND
  Hip fractures are associated with subsequent fractures, particularly in the year following initial fracture. Age-adjusted hip fracture rates have stabilised in many developed countries, but secular trends in subsequent fracture remain poorly documented. We thus evaluated secular trends (2000-2010) and determinants for the risk of a subsequent major (humerus, vertebral, or forearm) and any (non-hip) fracture after hip fracture.
  
  
  METHODS
  Patients ≥50 years with a hip fracture between 2000 and 2010 were extracted from the UK Clinical Practice Research Datalink (n = 30,516). Incidence rates, cumulative incidence probabilities, and adjusted hazard ratios (aHRs) were calculated.
  
  
  RESULTS
  Within 1 year following hip fracture, 2.7 and 8.4% of patients sustained a major or any (non-hip) fracture, which increased to 14.7 and 32.5% after 5 years, respectively. The most important risk factors for a subsequent major fracture within 1 year were the female gender [aHR 1.90, 95% confidence interval (CI) 1.51-2.40] and a history of secondary osteoporosis (aHR 1.54, 95% CI 1.17-2.02). The annual risk increased during the study period for both subsequent major (2009-2010 vs. 2000-2002: aHR 1.44, 95% CI 1.12-1.83) and any (non-hip) facture (2009-2010 vs. 2000-2002: aHR 1.80, 95% CI 1.58-2.06).
  
  
  CONCLUSIONS
  The risk of sustaining a major or any (non-hip) fracture after hip fracture is small in the first year. However, given the recent rise in secondary fracture rates and the substantial risk of subsequent fracture in the longer term, fracture prevention is clearly indicated for patients who have sustained a hip fracture.
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Gibson-Smith
authors.forename: C
authors.initials: C
authors.lastname: Klop
authors.forename: P J M
authors.initials: PJ
authors.lastname: Elders
authors.forename: P M J
authors.initials: PM
authors.lastname: Welsing
authors.forename: N
authors.initials: N
authors.lastname: van Schoor
authors.forename: H G M
authors.initials: HG
authors.lastname: Leufkens
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.forename: T P
authors.initials: TP
authors.lastname: van Staa
authors.forename: F
authors.initials: F
authors.lastname: de Vries
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution; D006113:United Kingdom / Q000453:epidemiology