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 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
, 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 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

^*Corresponding author for this work

Australian Catholic University
University of Sheffield
University of Gothenburg
Lund University
Skåne University Hospital
University of Massachusetts Medical School
Autonomous University of Barcelona
Generalitat de Catalunya
PRECIOSA-Fundación para la investigación
Nordic Bioscience AS
University of Liege
Maastricht University
University Hospital Zürich
University of Zurich
University Hospital of Geneva
University of Pittsburgh Graduate School of Public Health
Garvan Institute of Medical Research
University of New South Wales
University of Notre Dame Australia
Universite Claude Bernard Lyon 1
David Geffen School of Medicine
California Pacific Medical Center
University of Coimbra
Centro Hospitalar e Universitário de Coimbra
Tufts University
Hebrew SeniorLife
Amsterdam Public Health Research Institute
Kindai University
Yasuda Women's University
Universitätsklinikum Schleswig-Holstein
Maccabi Healthcare Services
Tel Aviv University
McGill University Health Centre
Icelandic Heart Association
University of Iceland
University of Edinburgh
University Hospital Lausanne
University of Aberdeen
Elisha Hospital
Menzies Institute for Medical Research
Mayo Clinic College of Medicine and Science
Yong Loo Lin School of Medicine
Agency for Science, Technology and Research, Singapore
Deakin University
Barwon Health
University of Melbourne
Kuopio University Hospital
University of Eastern Finland
Norwegian University of Science and Technology
Tehran University of Medical Sciences
University Hospital Bern
The Sahlgrenska Academy at the University of Gothenburg
Sahlgrenska University Hospital
University of Tromsø – The Arctic University of Norway
Mid Sweden University
Uppsala University
Manchester University NHS Foundation Trust
Centre for Epidemiology Versus Arthritis
Medical University of Graz
Center for Biomarker Research in Medicine
Oregon Health and Science University
Monash University
National Institutes of Health
Janus Rehabilitation
National Institute on Aging (Baltimore)
Université de Lyon
PHARMO Institute for Drug Outcomes Research
Osaka Medical and Pharmaceutical University
University of York
Hospital del Mar Medical Research Institute (IMIM)
MRC Epidemiology Unit
University of Alabama at Birmingham
The University of Tokyo
MRC Lifecourse Epidemiology Unit
University Hospital Southampton NHS Foundation Trust
University of Manitoba

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

91 Citations (Scopus)

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
Pages (from-to)	2027-2045
Number of pages	19
Journal	Osteoporosis International
Volume	34
Issue number	12
Early online date	11 Aug 2023
DOIs	https://doi.org/10.1007/s00198-023-06870-z
Publication status	Published - 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.

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10.1007/s00198-023-06870-z

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7615305/pdf/EMS187236.pdfLicence: CC BY

Cite this

Kanis, J. A., Johansson, H., McCloskey, E. V., Liu, E., Åkesson, K. E., Anderson, F. A., Azagra, R., Bager, C. L., Beaudart, C., Bischoff-Ferrari, H. A., 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, 34(12), 2027-2045. https://doi.org/10.1007/s00198-023-06870-z

@article{d69a655c6b324eca9c7c6a1813e0244f,

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{\textendash}2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95\% CI = 1.69{\textendash}2.07), major osteoporotic fracture (HR = 1.83; 95\% CI = 1.63{\textendash}2.06), or for hip fracture (HR = 1.82; 95\% CI = 1.62{\textendash}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.",

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 Bischoff-Ferrari, \{H. A.\} 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 = "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: {\textcopyright} 2023, International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.",

year = "2023",

month = dec,

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

language = "English",

volume = "34",

pages = "2027--2045",

journal = "Osteoporosis International",

issn = "0937-941X",

publisher = "Springer Science+Business Media",

number = "12",

}

Kanis, JA, Johansson, H, McCloskey, EV, Liu, E, Åkesson, KE, Anderson, FA, Azagra, R, Bager, CL, Beaudart, C, Bischoff-Ferrari, HA, 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, vol. 34, no. 12, pp. 2027-2045. https://doi.org/10.1007/s00198-023-06870-z

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 - Bischoff-Ferrari, H. A.

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 - 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.

PY - 2023/12

Y1 - 2023/12

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.

UR - https://www.scopus.com/pages/publications/85167687696

U2 - 10.1007/s00198-023-06870-z

DO - 10.1007/s00198-023-06870-z

M3 - Article

C2 - 37566158

AN - SCOPUS:85167687696

SN - 0937-941X

VL - 34

SP - 2027

EP - 2045

JO - Osteoporosis International

JF - Osteoporosis International

IS - 12

ER -

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

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