title: Preceding and subsequent high- and low-trauma fracture patterns-a 13-year epidemiological study in females and males in Austria.
abstract: This study investigated the implication of a preceding high-trauma fracture on subsequent high- and low-trauma fractures at different skeletal sites in postmenopausal women and similarly aged men at an age range of 54 to 70 years. A preceding high-trauma fracture increases the risk of future low-trauma non-vertebral fractures including hip.
  
  
  
  Little is known about the impact of the skeletal fracture site in conjunction with the severity of a past fracture (high- or low-trauma preceding fracture) and its effect on future fracture risk.
  
  
  
  Patients with de novo high- and low-trauma fractures admitted to seven large trauma centers across Austria between 2000 and 2012 were stratified into sex and different age groups. Kaplan-Meier estimates, Cox proportional hazards regression models (HR), and likelihood calculations estimated effects of age, sex, and the anatomic region on the probability of a subsequent fracture in the same patient.
  
  
  
  Included in the study were 433,499 female and male patients at an age range of 0 to 100 years with 575,772 de novo high- and low-trauma fractures. In the age range of 54-70 years, subsequent fractures were observed in 16% of females and 12.1% of males. A preceding high-trauma fracture was associated with 12.9% of subsequent fractures, thereof 6.5% of high- and 6.4% of low-trauma in origin, usually at the hip, humerus, or pelvis. The highest effect sizes were observed for femur, humerus, and thorax fractures with hazard ratios (HR) of 1.26, 1.18, and 1.14. After splitting into high-trauma preceding and subsequent low-trauma fractures, the femoral neck (HR = 1.59), the female sex (HR = 2.02), and age (HR = 1.03) were discriminators for increased future fracture risk.
  
  
  
  Preceding high-trauma fractures increase the risk of future low-trauma non-vertebral fractures including hip. For each patient with a fracture, regardless of the severity of the trauma, osteoporosis should be taken into clinical consideration.
authors.affiliation: St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria. christian.muschitz@bhs.at.
authors.forename: C
authors.initials: C
authors.lastname: Muschitz
authors.affiliation: St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Kocijan
authors.affiliation: Department of Statistics and Operations Research, The University of Vienna, Oskar-Morgenstern-Platz 1, 1090, Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Baierl
authors.affiliation: St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Dormann
authors.affiliation: St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.|AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria.
authors.forename: X
authors.initials: X
authors.lastname: Feichtinger
authors.affiliation: St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Haschka
authors.affiliation: Austrian Trauma Insurance Agency (AUVA), Adalbert-Stifter-Strasse 65, 1200, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Szivak
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, The Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: G K
authors.initials: GK
authors.lastname: Muschitz
authors.affiliation: AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Schanda
authors.affiliation: Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, The Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Pietschmann
authors.affiliation: St. Vincent Hospital Vienna, Medical Department II-Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria.|Karl Landsteiner Institute for Gastroenterology and Rheumatology, Stumpergasse 13, 1060, Vienna, Austria.|Bone Diseases Unit-Medical Faculty, Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Resch
authors.affiliation: Department of Internal Medicine, Division of Endocrinology and Metabolism, The Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria.
authors.forename: H P
authors.initials: HP
authors.lastname: Dimai
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D055815:Young Adult
keywords: High-trauma fractures; Hip fractures; Low-trauma fractures; Subsequent fractures