Abstract
The clinical significance of osteoporosis is in the occurrence of fractures and re-fractures. The main risk factor of sustaining a fracture is a previous one, but a recent fracture is a better fracture risk factor than fracture history. The role of the recency of fracture has been shown for both vertebral and non-vertebral fracture risk. This imminent risk is explained by both bone-related factors (underlying osteoporosis) and fall-related factors (including those related to postfracture care). Such a short-term increased risk has been shown also in patients initiating corticosteroids and in frail osteoporotic subjects with central nervous system (CNS) diseases or drugs targeting CNS, and thus a high risk of falls. Patients with an imminent (i.e. 2 years) risk of fracture or refracture should be identified in priority in order to receive an immediate treatment and a program of fall prevention.
Similar content being viewed by others
References
Bliuc D, Nguyen D, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521
Siris ES, Gehlbach S, Adachi JD, Boonen S, Chapurlat RD, Compston JE et al (2011) Failure to perceive increased risk of fracture in women 55 years and older: the Global Longitudinal Study of Osteoporosis in Women (GLOW). Osteoporos Int 22:27–35
Sale JE, Gignac MA, Hawker G, Beaton D, Frankel L, Bogoch E et al (2016) Patients do not have a consistent understanding of high risk for future fracture: a qualitative study of patients from a post-fracture secondary prevention program. Osteoporos Int 27:65–73
Alami S, Hervouet L, Poiraudeau S, Briot K, Roux C (2016) Barriers of effective postmenopausal osteoporosis treatment: a qualitative study of patients’ and practitioners’ views. PLoS One. doi:10.1371/journal.pone.0158365
Douglas F, Petrie KJ, Cundy T, Horne A, Gamble G, Grey A (2012) Differing perceptions of intervention thresholds for fracture risk: a survey of patients and doctors. Osteoporos Int 23:2135–2140
Van Staa TP, Leufkens HGM, Abenhaim B, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000
Amiche MA, Albaum JM, Tadrous M, Pechlivanoglou P, Lévesque LE, Adachi JD, Cadarette SM (2016) Fracture risk in oral glucocorticoid users: a Baysesian met-regression leveraging control arms of osteoporosis clinical trials. Osteoporos Int 27:1709–1718
Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297:387–394
van Geel TACM, van Helden S, Geusens PP, Winkens B, Dinant GJ (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68:99–102
Johansson H, Siggeirsdottir K, Harvey NC, Odén A, Gudnason V, Mc Closkey E et al (2016) Imminent risk of fracture after fracture. Osteoporos Int. doi:10.1007/s00198-016-3868-0
Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323
Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–1624
Huntjens KMB, Kosar S, van Geel TACM, Geusens PP, Willems P, Kessels A et al (2010) Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture. Osteoporos Int 21:2075–2082
Maravic M, Briot K, Roux C (2014) Burden of proximal humerus fractures in the French national hospital database. Orthopedics and Traumatology Surgery and Research 100:931–934
Clinton J, Franta A, Polissar NL, Neradilek B, Mounce D, Fink HA et al (2009) Proximal humeral fracture as a risk factor for subsequent hip fractures. J Bone Joint Surg Am 91:503–511
Schousboe JT, Fink HA, Taylor BC, Stone KL, Hillier TA, Nevitte MC et al (2005) Association between self-reported prior wrist fractures and risk of subsequent hip and radiographic vertebral fractures in older women: a prospective study. J Bone Miner Res 20:100–106
Berry SD, Samelson EJ, Ngo L, Bordes M, Broe KE, Kiel DP (2008) Subsequent fracture in nursing home residents with a hip fracture: a competing risks approach. J Am Geriatr Soc 56:1887–1892
Chen JS, Cameron ID, Simpson JM, Seibel MJ, March LM, Cummings RG et al (2011) Low-trauma fractures indicate increased risk of hip fracture in frail older people. J Bone and Miner Research 26:428–433
Ryg J, Rejnmark L, Overgaard S, Brixen K, Vestergaard P (2009) Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977–2001. J Bone Miner Res 24:1299–1307
Bynum JPW, Bell JE, Cantu RV, Wang Q, McDonough CM, Carmichael D et al (2016) Second fractures among older adults in the year following hip, shoulder, or wrist fracture. Osteoporos Int 27:2207–2215
Munson JC, Bynum JPW, Bell JE, Cantu R, Mc Donough C, Wang Q et al (2016) Patterns of prescription drug use before and after fragility fracture. JAMA Inter Med 176:1531–1538
Huntjens KMB, van Geel T, van den Bergh JPW, van Helden S, Willems P, Winkens B et al. Fracture liaison service: impact on subsequent non-vertebral fracture incidence and mortality. J Bone Joint Surg Am 2014; 96:e29(1–8).
Bawa HS, Weick J, Dirschl DR (2015) Anti-osteoporotic therapy after fragility fracture lowers rate of subsequent fracture. J Bone Joint Surg Am 97:1555–1562
Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC et al (2000) Fracture risk reduction with alendronate in women with osteoporosis: the fracture intervention trial. J Clin Endocrinol Metab 85:4118–4124
Harris ST, Watts NB, Genant HK, McKeever CK, Hangartner T, Keller M et al (1999) Effects of risedronate treatment on vertebral and non-vertebral fractures in women with post-menopausal osteoporosis. JAMA 282:1344–1352
Cummings SR, San Martin J, Mc Clung M, Siris E, Eastell R, Reid IR et al (2009) Denosumab for prevention of fractures in post-menopausal women with osteoporosis. N Engl J Med 361:756–765
Lyles KW, Colon-Emeric CS, Magazine JS, Adachi J, Pieper CF, Mautalen C et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809
Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY et al (2001) Effect of parathyroid hormone (1-34) on fractures and bone mineral density in post-menopausel women with osteoporosis. N Engl J Med 344:1434–1441
Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA et al (2016) Effect of abaloparatide vs placebo on new vertebral fractures in post-menopausal women with osteoporosis. JAMA 316:722–733
Cosman F, Crittenden DB, Adachi JD, Binkley N, Czerwinski E, Ferrari S et al (2016) Romosozumab treatment in post-menopausal women with osteoporosis. N Engl J Med 375:1532–1543
Huntjens K, van Geel T, van Helden S, van den Bergh J, Willems P, Winkens B et al (2013) The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk and mortality. BMC Musculoskelet Disord 14:121
Gill TM, Pahor M, Guralnik JM, Mc Dermott MM, King AC, Buford TW et al (2016) Effect of structured physical activity on prevention of serious fall injuries in adults ages 70–89: randomized clinical trial (LIFE study). BMJ 352:i245
El-Khoury F, Cassou B, Charles MD, Dargent-Molina P (2013) The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomized controlled trials. BMJ 347:f6234
Fitzgerald G, Boonen S, Comptson JE, Pfeilschifter J, Lacroix AZ, Hosmer DW (2012) Differing risk profiles for individual fracture sites: evidence from the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone and Miner Research 9:1907–1915
Bonafede M, Shi N, Barron R, Li X, Crittenden DB, Chandler D (2016) Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data. Arch Osteoporos 11:26
Masud T, Binkley N, Boonen S, Hannan MT, Members FPDC (2011) Official positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX®. J Clin Densitom 14:194–204
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Christian Roux received research grants and/or honoraria from the following: Alexion, Amgen, Lilly, and UCB. Karine Briot received research grants and/or honoraria from the following: Amgen, Lilly, MSD, and PFIZER.
Additional information
Learning objectives
On completion of this article, you should be able to recognize the following:
1. A recent fracture is a better fracture risk factor than fracture history.
2. The risk of falls must be assessed in osteoporotic patients with or without a recent fracture.
3. Frail elderly patients with osteoporosis and a high risk of falls can have an imminent risk of fracture.
4. Patients with an imminent (i.e. 2 years) fracture risk can be identified and should receive the highest priority for treatment and fall prevention.
Rights and permissions
About this article
Cite this article
Roux, C., Briot, K. Imminent fracture risk. Osteoporos Int 28, 1765–1769 (2017). https://doi.org/10.1007/s00198-017-3976-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-017-3976-5