Summary

The overall incidence of imminent fracture after a prior fragility fracture was 7.58% in the first year and 11.58% in the first 2 years. Approximately half of re-fractures occurred in the first 2 years after a fragility fracture. Older patients that have suffered from a fragility fracture should be treated promptly, with immediate care and a secondary fracture prevention to prevent the high imminent risk of a fracture.

Introduction

Imminent fractures refer to the fractures that occur within 2 years of an initial fracture. It is well known that the risk of a subsequent fracture is not constant with time and occurs shortly after the initial one. This systematic review and meta-analysis aimed to present the existing data on imminent fracture worldwide.

Methods

Literature search was conducted in Pubmed, Embase, and Web of Science databases until 26 October 2021 for studies reporting the incidence of imminent osteoporotic fractures among people aged 50 years or older. The overall incidence of imminent fracture was pooled and subgroup analyses of index fracture sites and regions on incidence of imminent fracture were performed, with the 95% confidence interval (CI) being calculated. Percentage of imminent fracture occurring in follow-up period was calculated and pooled by meta-analysis. Hazard ratio (HR) was used to estimate the gender differences on the imminent risk of fracture.

Results

A total of 1446 articles were identified. Nineteen observational studies were eligible for our systematic review, in which 18 were used for quantitative analysis. Pooled overall incidence of imminent fracture in the first year after an osteoporotic fracture was 7.58% (95% CI 5.84 to 9.31%) and cumulative incidence in the first 2 years was 11.58% (95% CI 8.94 to 14.21%). Subgroup analysis showed that in the first 2 years, the pooled incidence in Asia was 7.30% (95% CI 3.42 to 11.18%), whilst incidence in Europe/North America was 13.17% (95% CI 10.14 to 16.20%). In included studies with follow-up period of more than 5 years, pooled imminent fracture percentage in the first 2 years was 47.24% (95% CI 26.18 to 68.30%). Hazard ratio (HR) on gender showed that women had an overall slight increase in risk of imminent fractures (HR 1.18, 95% CI 1.11 to 1.25).

Conclusion

The incidence of imminent fracture is high globally at 11.58%. Approximately half of all refractures occur in the first 2 years after an index fragility fracture. Older patients that have suffered from a fragility fracture should be treated promptly. Also, immediate care and secondary fracture prevention are necessary to prevent the high imminent risk of a fracture, especially within the first 2 years.

中文翻译：

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骨折的迫在眉睫的风险——现有的全球数据：系统评价和荟萃分析

概括

先前的脆性骨折后即将发生骨折的总体发生率在第一年为 7.58%，在前 2 年为 11.58%。大约一半的再骨折发生在脆性骨折后的前 2 年。患有脆性骨折的老年患者应及时治疗，并立即进行护理和二级骨折预防，以防止骨折的高危风险。

介绍

即将发生的骨折是指在初次骨折后 2 年内发生的骨折。众所周知，后续骨折的风险不随时间而恒定，并且在最初的骨折后不久发生。该系统回顾和荟萃分析旨在呈现全球即将发生骨折的现有数据。

方法

在 Pubmed、Embase 和 Web of Science 数据库中进行文献检索，直至 2021 年 10 月 26 日，以研究报告 50 岁或以上人群中即将发生的骨质疏松性骨折的发生率。汇总即将发生骨折的总体发生率，并对指标骨折部位和区域对即将发生骨折的发生率进行亚组分析，计算 95% 置信区间 (CI)。通过荟萃分析计算和汇总随访期间即将发生骨折的百分比。危险比（HR）用于估计即将发生骨折风险的性别差异。

结果

共识别出 1446 篇文章。19 项观察性研究符合我们的系统评价条件，其中 18 项用于定量分析。骨质疏松性骨折后第一年即将发生骨折的综合总发生率为 7.58%（95% CI 5.84 至 9.31%），前 2 年的累积发生率为 11.58%（95% CI 8.94 至 14.21%）。亚组分析显示，在前 2 年，亚洲的合并发病率为 7.30%（95% CI 3.42 至 11.18%），而欧洲/北美的发病率为 13.17%（95% CI 10.14 至 16.20%）。在随访期超过 5 年的纳入研究中，前 2 年合并的即将发生骨折的百分比为 47.24%（95% CI 26.18 至 68.30%）。性别风险比 (HR) 显示，女性发生即将发生骨折的风险总体略有增加（HR 1.18, 95% CI 1.11 to 1.

结论

全球即将发生骨折的发生率高达 11.58%。大约一半的再骨折发生在指数脆性骨折后的前 2 年。患有脆性骨折的老年患者应及时治疗。此外，需要立即护理和预防继发性骨折，以防止即将发生的高骨折风险，尤其是在头 2 年内。