Risk factors of refracture after a fragility fracture in elderly

The study examined the risk factors of recurrent fragility fractures in elderly. Female and older age increased the risk of refracture. Older age at the first fracture also resulted in shorter time to the second fracture. The prevention program should be emphasized. Purpose The study examined the characteristics of the fragility fractures and refractures and the factors affecting the incidence and duration to the second fragility fracture. Methods The retrospective cohort study reviewed electronic medical records from Nan Provincial Public Health Office, Thailand. Patients aged >= 60 years with fragility fractures (hip, wrist, vertebra, and proximal humerus) from low-energy injuries between 1 January 2009 and 31 December 2018 were included. The characteristics of the first and second fractures and the factors that had effect on refracture incidence and duration were investigated. Results Among 4322 patients, 306 patients (7%) had subsequent fragility fractures. Risk factors of refracture included female (adjusted odd ratio 1.79, 95%CI 1.304-2.467) and older age at the first fracture (adjusted odd ratio 1.016, 95%CI 1.003-1.029). Factor resulted in shorter time to second fracture was older age at the first fracture (p-coefficient - 0.96, 95%CI - 1.4-(- 0.5)). Any type of the first fracture resulted in similar risk and duration to subsequent fracture. Half (48%) and two-third (65%) of the second fractures occurred within 3 and 4 years, respectively. Conclusion Female and older age were risk factors of subsequent fragility fracture. Older age resulted in shorter time to the second fracture. Refracture prevention program should be initiated in patients with any type of first fragility fracture and should be continued for at least 3-4 years.