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, H. A. Bischoff-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 journalArticleAcademicpeer-review

9 Citations (Scopus)


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 languageEnglish
Pages (from-to)2027-2045
Number of pages19
JournalOsteoporosis International
Issue number12
Early online date11 Aug 2023
Publication statusPublished - Dec 2023

Bibliographical note

Funding Information:
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.

Publisher Copyright:
© 2023, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.


Dive into the research topics of 'Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX'. Together they form a unique fingerprint.

Cite this