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Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study

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Abstract

Summary

Prior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma.

Introduction

Some have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures.

Methods

Using a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise.

Results

The study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08–1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47–1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture.

Conclusions

High-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk.

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy for use of 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. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Funding

No funding was received for this research. SNM is supported as a researcher and scholar from Fonds de Recherche du Québec en Santé. LML is supported by a Tier I Canada Research Chair.

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Correspondence to W. D. Leslie.

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Conflict of interest

Suzanne Morin: Nothing to declare for the context of this paper but has received research grants: Amgen and Merck

Eugene McCloskey: Nothing to declare for the context of this paper but numerous ad hoc consultancies/ speaking honoraria and/or research funding from Amgen, Bayer, General Electric, GSK, Hologic, Lilly, Merck Research Labs, Novartis, Novo Nordisk, Nycomed, Ono, Pfizer, ProStrakan, Roche, Sanofi-Aventis, Servier, Tethys, UBS, and Warner-Chilcott

Nicholas Harvey: Nothing to declare for the context of this paper, but has received consultancy/ lecture fees/ honoraria/ grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare, Radius Health, Kyowa Kirin, and Internis Pharma

John A. Kanis: Grants from Amgen, Lilly, Radius Health, and non-financial support from Medimaps outside the submitted work

William Leslie, Patrick Martineau, Lisa Lix, and Helena Johansson: No conflicts of interest

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Leslie, W.D., Schousboe, J.T., Morin, S.N. et al. Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study. Osteoporos Int 31, 1059–1067 (2020). https://doi.org/10.1007/s00198-019-05274-2

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