New research from Canada (unpublished) has found that men had a 3x higher risk of a secondary fracture within one year of a first fracture compared to those who did not, while the risk for women with a prior fracture was only 1.8x higher compared to women without one.
Study: Unusually High Chance of Secondary Fractures in Men
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Secondary#fracture#osteoporisis
The study, titled, “Changes in the Risk of Subsequent Major Osteoporotic Fractures over Time in Men and Women: A Population-Based Observational Study with 25-year Follow Up,” was presented at the American Society for Bone and Mineral Research Annual Meeting in Montreal.
Suzanne Morin, M.D., M. Sc., FRCPC, FACP, associate professor of Medicine, McGill University and her colleagues found that while the risk of secondary fracture was elevated in both men and women during that time period, it was highest in the first three years following a prior fracture.
Dr. Morin told OTW, “We were interested in this topic because it is known that patients who sustain an osteoporosis-related fractures are at high risk for sustaining another one over time. Though it was not quite clear, how this risk evolved over time and whether it evolved similarly in men and in women. So, we studied a large cohort of men and women (57,000 subjects) identified in healthcare administrative databases from Manitoba (Canada) over a 25-year period.”
“What we found is that men are at higher risk of have a subsequent fracture (following an initial one) than women and that this risk is very high in the first 3 years, then declines progressively but never comes back to the baseline risk of those who have never sustained fractures.”
“In women, the risk of subsequent fracture was also elevated in the first few years (though not as high as in men) and progressively declined as well over 25 years and again remained higher than those who had never sustained a fracture in the first place.”
“This is important, because if we can implement anti-fracture strategies (such as fall prevention or anti-osteoporosis medication prescription) early following an initial fracture, we might be able to reduce the risk of a second one (particularly in men).”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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