John A Kanis1,2,3, Helena Johansson4,5, Nicholas C Harvey6,7, Vilmundur Gudnason8,9, Gunnar Sigurdsson8, Kristin Siggeirsdottir8, Mattias Lorentzon4,10, Enwu Liu4, Liesbeth Vandenput4,11, Eugene V McCloskey5,12. 1. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. w.j.pontefract@shef.ac.uk. 2. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. w.j.pontefract@shef.ac.uk. 3. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK. w.j.pontefract@shef.ac.uk. 4. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. 5. Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK. 6. MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK. 7. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK. 8. Icelandic Heart Association Research Institute, Kopavogur, Iceland. 9. University of Iceland, Reykjavik, Iceland. 10. Geriatric Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. 11. Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 12. Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK.
Abstract
The risk of a recurrent fragility fracture is high following a first fracture and higher still with more than one prior fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior fractures. INTRODUCTION: Prior fractures increase subsequent fracture risk. The aim of this study was to quantify the effect of the number of prior fractures on the 10-year probability of fracture determined with FRAX®. METHODS: The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of prior osteoporotic fractures over a 20-year interval from the hazards of death and fracture. Fracture probabilities were also computed for a prior osteoporotic fracture irrespective of the number of previous fractures. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures. RESULTS: Probability ratios to adjust 10-year FRAX probabilities of a hip fracture and MOF increased with the number of prior fractures but decreased with age in both men and women. Probability ratios were similar in men and women and for hip fracture and MOF. Mean probability ratios according to the number of prior fractures for all scenarios were 0.95, 1.08, 1.21 and 1.35, for 1,2, 3 and 4 or more prior fractures, respectively. Thus, a simple rule of thumb is to downward adjust FRAX-based fracture probabilities by 5% in the presence of a single prior fracture and to uplift probabilities by 10, 20 and 30% with a history of 2, 3 and 4 or more prior fractures, respectively. CONCLUSION: The probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.
The risk of a recurrent fragility fracture is high following a first fracture and higher still with more than one prior fracture. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior fractures. INTRODUCTION: Prior fractures increase subsequent fracture risk. The aim of this study was to quantify the effect of the number of prior fractures on the 10-year probability of fracture determined with FRAX®. METHODS: The study used data from the Reykjavik Study fracture register that documented prospectively all fractures at all skeletal sites in a large sample of the population of Iceland. Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of prior osteoporotic fractures over a 20-year interval from the hazards of death and fracture. Fracture probabilities were also computed for a prior osteoporotic fracture irrespective of the number of previous fractures. The probability ratios provided adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures. RESULTS: Probability ratios to adjust 10-year FRAX probabilities of a hip fracture and MOF increased with the number of prior fractures but decreased with age in both men and women. Probability ratios were similar in men and women and for hip fracture and MOF. Mean probability ratios according to the number of prior fractures for all scenarios were 0.95, 1.08, 1.21 and 1.35, for 1,2, 3 and 4 or more prior fractures, respectively. Thus, a simple rule of thumb is to downward adjust FRAX-based fracture probabilities by 5% in the presence of a single prior fracture and to uplift probabilities by 10, 20 and 30% with a history of 2, 3 and 4 or more prior fractures, respectively. CONCLUSION: The probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior fractures.
Authors: Celia L Gregson; David J Armstrong; Jean Bowden; Cyrus Cooper; John Edwards; Neil J L Gittoes; Nicholas Harvey; John Kanis; Sarah Leyland; Rebecca Low; Eugene McCloskey; Katie Moss; Jane Parker; Zoe Paskins; Kenneth Poole; David M Reid; Mike Stone; Julia Thomson; Nic Vine; Juliet Compston Journal: Arch Osteoporos Date: 2022-04-05 Impact factor: 2.879
Authors: John A Kanis; Nicholas C Harvey; Cyrus Cooper; Helena Johansson; Anders Odén; Eugene V McCloskey Journal: Arch Osteoporos Date: 2016-07-27 Impact factor: 2.617
Authors: Bente Langdahl; Lorenz C Hofbauer; Serge Ferrari; Zhenxun Wang; Astrid Fahrleitner-Pammer; Evelien Gielen; Péter Lakatos; Edward Czerwinski; Esteban Jódar Gimeno; Jen Timoshanko; Mary Oates; Cesar Libanati Journal: Osteoporos Int Date: 2022-09-29 Impact factor: 5.071