title: Second fractures among older adults in the year following hip, shoulder, or wrist fracture.
abstract: We report on second fracture occurrence in the year following a hip, shoulder or wrist fracture using insurance claims. Among 273,330 people, 4.3 % had a second fracture; risk did not differ by first fracture type. Estimated adjusted second fracture probabilities may facilitate population-based evaluation of secondary fracture prevention strategies.
  
  
  
  The purpose of this study was estimate second fracture risk for the older US population in the year following a hip, shoulder, or wrist fracture.
  
  
  
  Observational cohort study of Medicare fee-for-service beneficiaries with an index hip, shoulder, or wrist fragility fracture in 2009. Time-to-event analyses using Cox proportional hazards models to characterize the relationship between index fracture type (hip, shoulder, wrist) and patient factors (age, gender, and comorbidity) on second fracture risk in the year following the index fracture.
  
  
  
  Among 273,330 individuals with fracture, 11,885 (4.3 %) sustained a second hip, shoulder or wrist fracture within one year. Hip fracture was most common, regardless of the index fracture type. Comparing adjusted second fracture risks across index fracture types reveals that the magnitude of second fracture risk within each age-comorbidity group is similar regardless of the index fracture. Men and women face similar risks with frequently overlapping confidence intervals, except among women aged 85 years or older who are at greater risk.
  
  
  
  Regardless of index fracture type, second fractures are common in the year following hip, shoulder or wrist fracture. Secondary fracture prevention strategies that take a population perspective should be informed by these estimates which take competing mortality risks into account.
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH, 03756, USA. julie.bynum@dartmouth.edu.|Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. julie.bynum@dartmouth.edu.
authors.forename: J P W
authors.initials: JPW
authors.lastname: Bynum
authors.affiliation: Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: J-E
authors.initials: JE
authors.lastname: Bell
authors.affiliation: Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: R V
authors.initials: RV
authors.lastname: Cantu
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH, 03756, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH, 03756, USA.|The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: McDonough
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH, 03756, USA.
authors.forename: D
authors.initials: D
authors.lastname: Carmichael
authors.affiliation: Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.|Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Tosteson
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5 One Medical Center Drive, Lebanon, NH, 03756, USA.|Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.|Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
authors.forename: A N A
authors.initials: ANA
authors.lastname: Tosteson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D008297:Male; D006278:Medicare; D012307:Risk Factors; D012782:Shoulder / Q000473:pathology; D012784:Shoulder Fractures / Q000453:epidemiology*; D014481:United States; D014953:Wrist / Q000473:pathology; D014954:Wrist Injuries / Q000453:epidemiology*
keywords: Hip fracture; Osteoporosis; Risk; Shoulder fracture; Wrist fracture