Risk of subsequent fracture after prior fracture among older women

Among 377,561 female Medicare beneficiaries who sustained a fracture, 10% had another fracture within 1year, 18% within 2years, and 31% within 5years. Timely management to reduce risk of subsequent fracture is warranted following all nontraumatic fractures, including nonhip nonvertebral fractures, in older women.IntroductionPrior fracture is a strong predictor of subsequent fracture; however, postfracture treatment rates are low. Quantifying imminent (12-24 month) risk of subsequent fracture in older women may clarify the need for early postfracture management.MethodsThis retrospective cohort study used Medicare administrative claims data. Women 65years who sustained a clinical fracture (clinical vertebral and nonvertebral fracture; index date) and were continuously enrolled for 1-year pre-index and 1-year (2 or 5years for outcomes at those time points) post-index were included. Cumulative incidence of subsequent fracture was calculated from 30days post-index to 1, 2, and 5years post-index. For appendicular fractures, only those requiring hospitalization or surgical repair were counted. Death was considered a competing risk.ResultsAmong 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5years post-index, respectively. Among women age 65-74years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women 75years regardless of initial fracture site (except ankle and tibia/fibula), 7-14% fractured again within 1year depending on initial fracture site; risk rose to 15-26% within 2years and 28-42% within 5years. Risk of subsequent hip fracture exceeded 3% within 5years in all women studied, except those <75years with an initial tibia/fibula or ankle fracture.ConclusionsWe observed a high and early risk of subsequent fracture following a broad array of initial fractures. Timely management with consideration of pharmacotherapy is warranted in older women following all fracture types evaluated.