Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX

J. A. Kanis; H. Johansson; E. V. McCloskey; E. Liu; K. E. Åkesson; F. A. Anderson; R. Azagra; C. L. Bager; C. Beaudart; S. Ferrari; E. Biver; O. Bruyère; J. A. Cauley; J. R. Center; R. Chapurlat; C. Christiansen; C. Cooper; C. J. Crandall; S. R. Cummings; J. A.P. da Silva; B. Dawson-Hughes; A. Diez-Perez; A. B. Dufour; J. A. Eisman; P. J.M. Elders; S. Ferrari; Y. Fujita; S. Fujiwara; C. C. Glüer; I. Goldshtein; D. Goltzman; V. Gudnason; J. Hall; D. Hans; M. Hoff; R. J. Hollick; M. Huisman; M. Iki; S. Ish-Shalom; G. Jones; M. K. Karlsson; S. Khosla; D. P. Kiel; W. P. Koh; F. Koromani; M. A. Kotowicz; H. Kröger; T. Kwok; O. Lamy; A. Langhammer; B. Larijani; K. Lippuner; D. Mellström; T. Merlijn; A. Nordström; P. Nordström; T. W. O’Neill; B. Obermayer-Pietsch; C. Ohlsson; E. S. Orwoll; J. A. Pasco; F. Rivadeneira; A. M. Schott; E. J. Shiroma; K. Siggeirsdottir; E. M. Simonsick; E. Sornay-Rendu; R. Sund; K. M.A. Swart; P. Szulc; J. Tamaki; D. J. Torgerson; N. M. van Schoor; T. P. van Staa; J. Vila; N. J. Wareham; N. C. Wright; N. Yoshimura; M. C. Zillikens; M. Zwart; L. Vandenput; N. C. Harvey; M. Lorentzon; W. D. Leslie

doi:10.1007/s00198-023-06870-z

Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX

J. A. Kanis^*, H. Johansson, E. V. McCloskey, E. Liu, K. E. Åkesson, F. A. Anderson, R. Azagra, C. L. Bager, C. Beaudart, S. Ferrari, E. Biver, O. Bruyère, J. A. Cauley, J. R. Center, R. Chapurlat, C. Christiansen, C. Cooper, C. J. Crandall, S. R. Cummings, J. A.P. da SilvaB. Dawson-Hughes, A. Diez-Perez, A. B. Dufour, J. A. Eisman, P. J.M. Elders, S. Ferrari, Y. Fujita, S. Fujiwara, C. C. Glüer, I. Goldshtein, D. Goltzman, V. Gudnason, J. Hall, D. Hans, M. Hoff, R. J. Hollick, M. Huisman, M. Iki, S. Ish-Shalom, G. Jones, M. K. Karlsson, S. Khosla, D. P. Kiel, W. P. Koh, F. Koromani, M. A. Kotowicz, H. Kröger, T. Kwok, O. Lamy, A. Langhammer, B. Larijani, K. Lippuner, D. Mellström, T. Merlijn, A. Nordström, P. Nordström, T. W. O’Neill, B. Obermayer-Pietsch, C. Ohlsson, E. S. Orwoll, J. A. Pasco, F. Rivadeneira, A. M. Schott, E. J. Shiroma, K. Siggeirsdottir, E. M. Simonsick, E. Sornay-Rendu, R. Sund, K. M.A. Swart, P. Szulc, J. Tamaki, D. J. Torgerson, N. M. van Schoor, T. P. van Staa, J. Vila, N. J. Wareham, N. C. Wright, N. Yoshimura, M. C. Zillikens, M. Zwart, L. Vandenput, N. C. Harvey, M. Lorentzon, W. D. Leslie

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Summary: A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. Introduction: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). Methods: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. Results: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72–2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69–2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63–2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62–2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. Conclusion: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.

Original language	English
Journal	Osteoporosis International
Early online date	11 Aug 2023
DOIs	https://doi.org/10.1007/s00198-023-06870-z
Publication status	E-pub ahead of print - 11 Aug 2023

Bibliographical note

Biobank data are included under approved access agreement 3593. The authors acknowledge the Manitoba Centre for Health Policy for use of Manitoba data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred.

Funding
The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005.

Keywords

Hip fracture
Major osteoporotic fracture
Meta-analysis
Osteoporotic fracture
Prior fracture

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00198-023-06870-zLicence: Unspecified

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Kanis, J. A., Johansson, H., McCloskey, E. V., Liu, E., Åkesson, K. E., Anderson, F. A., Azagra, R., Bager, C. L., Beaudart, C., Ferrari, S., Biver, E., Bruyère, O., Cauley, J. A., Center, J. R., Chapurlat, R., Christiansen, C., Cooper, C., Crandall, C. J., Cummings, S. R., ... Leslie, W. D. (2023). Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX. Osteoporosis International. Advance online publication. https://doi.org/10.1007/s00198-023-06870-z

Kanis, JA, Johansson, H, McCloskey, EV, Liu, E, Åkesson, KE, Anderson, FA, Azagra, R, Bager, CL, Beaudart, C, Ferrari, S, Biver, E, Bruyère, O, Cauley, JA, Center, JR, Chapurlat, R, Christiansen, C, Cooper, C, Crandall, CJ, Cummings, SR, da Silva, JAP, Dawson-Hughes, B, Diez-Perez, A, Dufour, AB, Eisman, JA, Elders, PJM, Ferrari, S, Fujita, Y, Fujiwara, S, Glüer, CC, Goldshtein, I, Goltzman, D, Gudnason, V, Hall, J, Hans, D, Hoff, M, Hollick, RJ, Huisman, M, Iki, M, Ish-Shalom, S, Jones, G, Karlsson, MK, Khosla, S, Kiel, DP, Koh, WP, Koromani, F, Kotowicz, MA, Kröger, H, Kwok, T, Lamy, O, Langhammer, A, Larijani, B, Lippuner, K, Mellström, D, Merlijn, T, Nordström, A, Nordström, P, O’Neill, TW, Obermayer-Pietsch, B, Ohlsson, C, Orwoll, ES, Pasco, JA, Rivadeneira, F, Schott, AM, Shiroma, EJ, Siggeirsdottir, K, Simonsick, EM, Sornay-Rendu, E, Sund, R, Swart, KMA, Szulc, P, Tamaki, J, Torgerson, DJ, van Schoor, NM, van Staa, TP, Vila, J, Wareham, NJ, Wright, NC, Yoshimura, N, Zillikens, MC, Zwart, M, Vandenput, L, Harvey, NC, Lorentzon, M & Leslie, WD 2023, 'Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX', Osteoporosis International. https://doi.org/10.1007/s00198-023-06870-z

@article{9f8d1ae7941f45b0a8d0b38a50dbede9,

title = "Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX",

abstract = "Summary: A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. Introduction: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). Methods: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. Results: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72–2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69–2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63–2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62–2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. Conclusion: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.",

keywords = "Hip fracture, Major osteoporotic fracture, Meta-analysis, Osteoporotic fracture, Prior fracture",

author = "Kanis, {J. A.} and H. Johansson and McCloskey, {E. V.} and E. Liu and {\AA}kesson, {K. E.} and Anderson, {F. A.} and R. Azagra and Bager, {C. L.} and C. Beaudart and S. Ferrari and E. Biver and O. Bruy{\`e}re and Cauley, {J. A.} and Center, {J. R.} and R. Chapurlat and C. Christiansen and C. Cooper and Crandall, {C. J.} and Cummings, {S. R.} and {da Silva}, {J. A.P.} and B. Dawson-Hughes and A. Diez-Perez and Dufour, {A. B.} and Eisman, {J. A.} and Elders, {P. J.M.} and S. Ferrari and Y. Fujita and S. Fujiwara and Gl{\"u}er, {C. C.} and I. Goldshtein and D. Goltzman and V. Gudnason and J. Hall and D. Hans and M. Hoff and Hollick, {R. J.} and M. Huisman and M. Iki and S. Ish-Shalom and G. Jones and Karlsson, {M. K.} and S. Khosla and Kiel, {D. P.} and Koh, {W. P.} and F. Koromani and Kotowicz, {M. A.} and H. Kr{\"o}ger and T. Kwok and O. Lamy and A. Langhammer and B. Larijani and K. Lippuner and D. Mellstr{\"o}m and T. Merlijn and A. Nordstr{\"o}m and P. Nordstr{\"o}m and O{\textquoteright}Neill, {T. W.} and B. Obermayer-Pietsch and C. Ohlsson and Orwoll, {E. S.} and Pasco, {J. A.} and F. Rivadeneira and Schott, {A. M.} and Shiroma, {E. J.} and K. Siggeirsdottir and Simonsick, {E. M.} and E. Sornay-Rendu and R. Sund and Swart, {K. M.A.} and P. Szulc and J. Tamaki and Torgerson, {D. J.} and {van Schoor}, {N. M.} and {van Staa}, {T. P.} and J. Vila and Wareham, {N. J.} and Wright, {N. C.} and N. Yoshimura and Zillikens, {M. C.} and M. Zwart and L. Vandenput and Harvey, {N. C.} and M. Lorentzon and Leslie, {W. D.}",

note = "Biobank data are included under approved access agreement 3593. The authors acknowledge the Manitoba Centre for Health Policy for use of Manitoba data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. Funding The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005.",

year = "2023",

month = aug,

day = "11",

doi = "10.1007/s00198-023-06870-z",

language = "English",

journal = "Osteoporosis International",

issn = "0937-941X",

publisher = "SPRINGER-VERLAG LONDON LTD",

}

TY - JOUR

T1 - Previous fracture and subsequent fracture risk

T2 - a meta-analysis to update FRAX

AU - Kanis, J. A.

AU - Johansson, H.

AU - McCloskey, E. V.

AU - Liu, E.

AU - Åkesson, K. E.

AU - Anderson, F. A.

AU - Azagra, R.

AU - Bager, C. L.

AU - Beaudart, C.

AU - Ferrari, S.

AU - Biver, E.

AU - Bruyère, O.

AU - Cauley, J. A.

AU - Center, J. R.

AU - Chapurlat, R.

AU - Christiansen, C.

AU - Cooper, C.

AU - Crandall, C. J.

AU - Cummings, S. R.

AU - da Silva, J. A.P.

AU - Dawson-Hughes, B.

AU - Diez-Perez, A.

AU - Dufour, A. B.

AU - Eisman, J. A.

AU - Elders, P. J.M.

AU - Ferrari, S.

AU - Fujita, Y.

AU - Fujiwara, S.

AU - Glüer, C. C.

AU - Goldshtein, I.

AU - Goltzman, D.

AU - Gudnason, V.

AU - Hall, J.

AU - Hans, D.

AU - Hoff, M.

AU - Hollick, R. J.

AU - Huisman, M.

AU - Iki, M.

AU - Ish-Shalom, S.

AU - Jones, G.

AU - Karlsson, M. K.

AU - Khosla, S.

AU - Kiel, D. P.

AU - Koh, W. P.

AU - Koromani, F.

AU - Kotowicz, M. A.

AU - Kröger, H.

AU - Kwok, T.

AU - Lamy, O.

AU - Langhammer, A.

AU - Larijani, B.

AU - Lippuner, K.

AU - Mellström, D.

AU - Merlijn, T.

AU - Nordström, A.

AU - Nordström, P.

AU - O’Neill, T. W.

AU - Obermayer-Pietsch, B.

AU - Ohlsson, C.

AU - Orwoll, E. S.

AU - Pasco, J. A.

AU - Rivadeneira, F.

AU - Schott, A. M.

AU - Shiroma, E. J.

AU - Siggeirsdottir, K.

AU - Simonsick, E. M.

AU - Sornay-Rendu, E.

AU - Sund, R.

AU - Swart, K. M.A.

AU - Szulc, P.

AU - Tamaki, J.

AU - Torgerson, D. J.

AU - van Schoor, N. M.

AU - van Staa, T. P.

AU - Vila, J.

AU - Wareham, N. J.

AU - Wright, N. C.

AU - Yoshimura, N.

AU - Zillikens, M. C.

AU - Zwart, M.

AU - Vandenput, L.

AU - Harvey, N. C.

AU - Lorentzon, M.

AU - Leslie, W. D.

N1 - Biobank data are included under approved access agreement 3593. The authors acknowledge the Manitoba Centre for Health Policy for use of Manitoba data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. Funding The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through 75N92021D00001, 75N92021D00002, 75N92021D00003, 75N92021D00004, and 75N92021D00005.

PY - 2023/8/11

Y1 - 2023/8/11

N2 - Summary: A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. Introduction: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). Methods: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. Results: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72–2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69–2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63–2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62–2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. Conclusion: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.

AB - Summary: A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. Introduction: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). Methods: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. Results: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72–2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69–2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63–2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62–2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. Conclusion: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.

KW - Hip fracture

KW - Major osteoporotic fracture

KW - Meta-analysis

KW - Osteoporotic fracture

KW - Prior fracture

UR - http://www.scopus.com/inward/record.url?scp=85167687696&partnerID=8YFLogxK

U2 - 10.1007/s00198-023-06870-z

DO - 10.1007/s00198-023-06870-z

M3 - Article

C2 - 37566158

AN - SCOPUS:85167687696

SN - 0937-941X

JO - Osteoporosis International

JF - Osteoporosis International

ER -

Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX

Abstract

Bibliographical note

Keywords

UN SDGs

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