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Preceding and subsequent high- and low-trauma fracture patterns—a 13-year epidemiological study in females and males in Austria

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Abstract

Summary

This study investigated the implication of a preceding high-trauma fracture on subsequent high- and low-trauma fractures at different skeletal sites in postmenopausal women and similarly aged men at an age range of 54 to 70 years. A preceding high-trauma fracture increases the risk of future low-trauma non-vertebral fractures including hip.

Introduction

Little is known about the impact of the skeletal fracture site in conjunction with the severity of a past fracture (high- or low-trauma preceding fracture) and its effect on future fracture risk.

Methods

Patients with de novo high- and low-trauma fractures admitted to seven large trauma centers across Austria between 2000 and 2012 were stratified into sex and different age groups. Kaplan-Meier estimates, Cox proportional hazards regression models (HR), and likelihood calculations estimated effects of age, sex, and the anatomic region on the probability of a subsequent fracture in the same patient.

Results

Included in the study were 433,499 female and male patients at an age range of 0 to 100 years with 575,772 de novo high- and low-trauma fractures. In the age range of 54–70 years, subsequent fractures were observed in 16% of females and 12.1% of males. A preceding high-trauma fracture was associated with 12.9% of subsequent fractures, thereof 6.5% of high- and 6.4% of low-trauma in origin, usually at the hip, humerus, or pelvis. The highest effect sizes were observed for femur, humerus, and thorax fractures with hazard ratios (HR) of 1.26, 1.18, and 1.14. After splitting into high-trauma preceding and subsequent low-trauma fractures, the femoral neck (HR = 1.59), the female sex (HR = 2.02), and age (HR = 1.03) were discriminators for increased future fracture risk.

Conclusions

Preceding high-trauma fractures increase the risk of future low-trauma non-vertebral fractures including hip. For each patient with a fracture, regardless of the severity of the trauma, osteoporosis should be taken into clinical consideration.

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Acknowledgements

The authors cordially thank Sabine Klauss at Ulm/Germany for the graphic design of the figures and Prof. Tommy Vacca at Linz/Austria for proofreading. The authors furthermore thank Corinna Geiger, M.D., and Daniel Amesberger for their contributions in the analysis of a subset of the database.

Author information

Authors and Affiliations

  1. St. Vincent Hospital Vienna, Medical Department II—Metabolic Bone Diseases Unit, VINFORCE, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria

    C. Muschitz, R. Kocijan, R. Dormann, X. Feichtinger, J. Haschka & H. Resch

  2. Department of Statistics and Operations Research, The University of Vienna, Oskar-Morgenstern-Platz 1, 1090, Vienna, Austria

    A. Baierl

  3. AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria

    X. Feichtinger & J. Schanda

  4. Austrian Trauma Insurance Agency (AUVA), Adalbert-Stifter-Strasse 65, 1200, Vienna, Austria

    M. Szivak

  5. Division of Plastic and Reconstructive Surgery, Department of Surgery, The Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    G. K. Muschitz

  6. Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, The Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    P. Pietschmann

  7. Karl Landsteiner Institute for Gastroenterology and Rheumatology, Stumpergasse 13, 1060, Vienna, Austria

    H. Resch

  8. Bone Diseases Unit—Medical Faculty, Sigmund Freud University, Freudplatz 1, 1020, Vienna, Austria

    H. Resch

  9. Department of Internal Medicine, Division of Endocrinology and Metabolism, The Medical University of Graz, Auenbruggerplatz 2, 8036, Graz, Austria

    H. P. Dimai

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  1. C. Muschitz
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Corresponding author

Correspondence to C. Muschitz.

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Conflicts of interest

CM has received speaker honoraria from Amgen, Novartis, Servier, Eli Lilly, Nycomed Pharma/Takeda, Kwizda Pharma, Boehringer Ingelheim, Actavis, and Daiichi-Sankyo. CM has received educational grants/research support from the Austrian Society for Bone and Mineral Research, Roche Austria, Eli Lilly Austria, Eli Lilly International, and Amgen Austria. He has nothing to disclose concerning this manuscript.

RK has received speaker honoraria from Eli Lilly. He has nothing to disclose concerning this manuscript.

HPD reports serving on the board and receiving consulting fees and payment for travel accommodations from Novartis, Nycomed, Amgen, Eli Lilly, Merck Sharp & Dohme, Servier, and Daiichi-Sankyo; lecture fees from Novartis, Nycomed, Amgen, Eli Lilly, Merck Sharp & Dohme, Servier, Kyphon, and Daiichi-Sankyo; payment for manuscript preparation from Amgen and Servier; payment for development of educational presentations from Servier and Merck Sharp & Dohme; and grant support to his institution, the Medical University of Graz, from Novartis, Nycomed, Amgen, Eli Lilly, Merck Sharp & Dohme, Servier, and Kyphon. He has nothing to disclose concerning this manuscript.

PP has received research support and/or honoraria from Amgen GmbH, Eli Lilly GmbH, Fresenius Kabi Austria GmbH, Merck, Sharp and Dohme GmbH, Novartis Pharma, Nycomed Pharma, Roche Austria, Servier Austria, Sanofi-Austria, and Sinapharm. He has nothing to disclose concerning this manuscript.

HR received speaker honoraria from Amgen, Novartis, Servier, Eli Lilly, and Nycomed Pharma/Takeda. He has further received educational grants/research support from the Austrian Society for Bone and Mineral Research, Roche Austria, Eli Lilly Austria, Eli Lilly International, and Amgen Austria. He has nothing to disclose concerning this manuscript.

All other authors have nothing to disclose.

Funding source

Independent research grant of AMGEN Austria Ltd.

Electronic supplementary material

Supplemental Table 1

Percentages of different types of ipsi- and contralateral subsequent fractures after different types of preceding fractures, subdivided by skeletal regions. (DOCX 33 kb)

Supplemental Figure 1

Percentage distribution of all patients with high- and low-trauma fractures according to age. (JPEG 285 kb)

High Resolution (EPS 709 kb)

Supplemental Figure 2

Probability of no subsequent ipsi- and contralateral fracture for all patients aged 54–70 years (Panel A) and for female and male patients aged 54–70 years (Panel B). Panel C describes the probability of no subsequent ipsi- and contralateral low-trauma fracture for female and male patients aged 54–70 years. (JPEG 246 kb)

High Resolution (EPS 715 kb)

(JPEG 228 kb)

High Resolution (EPS 713 kb)

(JPEG 238 kb)

High Resolution (EPS 715 kb)

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Muschitz, C., Kocijan, R., Baierl, A. et al. Preceding and subsequent high- and low-trauma fracture patterns—a 13-year epidemiological study in females and males in Austria. Osteoporos Int 28, 1609–1618 (2017). https://doi.org/10.1007/s00198-017-3925-3

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