title: Imminent risk of fracture after fracture.
abstract: The risk of major osteoporotic fracture (MOF) after a first MOF is increased over the whole duration of follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner.
  
  
  
  A history of fracture is a strong risk factor for future fractures. The aim of the present study was to determine whether the predictive value of a past MOF for future MOF changed with time.
  
  
  
  The study was based on a population-based cohort of 18,872 men and women born between 1907 and 1935. Fractures were documented over 510,265 person-years. An extension of Poisson regression was used to investigate the relationship between the first MOF and the second. All associations were adjusted for age and time since baseline.
  
  
  
  Five thousand thirty-nine individuals sustained one or more MOFs, of whom 1919 experienced a second MOF. The risk of a second MOF after a first increased by 4% for each year of age (95% CI 1.02-1.06) and was 41% higher for women than men (95% CI 1.25-1.59). The risk of a second MOF was highest immediately after the first fracture and thereafter decreased with time though remained higher than the population risk throughout follow-up. For example, 1 year after the first MOF, the risk of a second fracture was 2.7 (2.4-3.0) fold higher than the population risk. After 10 years, this risk ratio was 1.4 (1.2-1.6). The effect was more marked with increasing age.
  
  
  
  The risk of MOF after a first MOF is increased over the whole follow-up, but the imminent risk is even higher. If the acute increment in risk in the few years following MOF is amenable to therapeutic intervention, then immediate short-term treatments may provide worthwhile clinical dividends in a very cost-effective manner, particularly in the elderly.
authors.affiliation: Institute for Health and Aging, Australian Catholic University, Melbourne, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Johansson
authors.affiliation: Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: K
authors.initials: K
authors.lastname: Siggeirsdóttir
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.|NIHR Southampton Biomedical Research Centre, University of Southampton and University, Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.affiliation: Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
authors.forename: A
authors.initials: A
authors.lastname: Odén
authors.affiliation: Icelandic Heart Association, Kopavogur, Iceland.|University of Iceland, Reykjavik, Iceland.
authors.forename: V
authors.initials: V
authors.lastname: Gudnason
authors.affiliation: Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK.
authors.forename: E
authors.initials: E
authors.lastname: McCloskey
authors.affiliation: Icelandic Heart Association, Kopavogur, Iceland.
authors.forename: G
authors.initials: G
authors.lastname: Sigurdsson
authors.affiliation: Institute for Health and Aging, Australian Catholic University, Melbourne, Australia. w.j.pontefract@sheffield.ac.uk.|Centre for Metabolic Bone Diseases, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK. w.j.pontefract@sheffield.ac.uk.
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D016012:Poisson Distribution; D012008:Recurrence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055502:Secondary Prevention
keywords: Epidemiology; Iceland; Osteoporotic fracture; Poisson regression model; Second fracture