Traumatic fractures associated with subsequent fracture risk in postmenopausal women
Data from the Women's Health Initiative suggest that either a high-trauma or low-trauma fracture warrants evaluation for osteoporosis and counseling about fracture risk.
Having one fracture was associated with a greater risk of subsequent fracture among postmenopausal women older than age 50 years, regardless of whether the initial fracture was traumatic or nontraumatic, according to an analysis of data from the Women's Health Initiative (WHI).
To determine how future fracture risk varies when the initial fracture is traumatic or nontraumatic, the WHI Clinical Trials and WHI Bone Density Substudy at three centers asked its participants, postmenopausal women ages 50 to 79 years, to report the mechanism of incident fractures. Information about incident fracture and covariates was available for 66,874 participants. Incident clinical fractures were self-reported at least annually and confirmed using medical records. Results were published by JAMA Internal Medicine on June 7.
Overall, 7,142 (10.7%) incident fractures occurred during the study follow-up period. The adjusted hazard ratio (aHR) of subsequent fracture after either kind of initial fracture was 1.49 (95% CI, 1.38 to 1.61). The increased risk for a subsequent fracture was significant in both the patients with a traumatic fracture (aHR, 1.25; 95% CI, 1.06 to 1.48) and those with a nontraumatic one (aHR, 1.52; 95% CI, 1.37 to 1.68). The authors noted the overlapping confidence intervals of these hazard ratios.
“This study's findings suggest that all fractures, whether traumatic or nontraumatic, should warrant evaluation for osteoporosis (including [bone mineral density] testing) and counseling regarding subsequent increased fracture risk,” the authors wrote. “These results advance our understanding of the burden of potentially preventable fractures, which is higher in women with initial traumatic fractures as well as those with initial nontraumatic fractures.”
An accompanying editorial noted the clinical relevance of these findings. “The idea that nontraumatic vs traumatic is a distinction without a difference will likely be welcomed by busy clinicians,” it said. “What clinician would not appreciate being relieved of the tedium of trying to accurately interrogate a patient about the energy and impact of the fall, the step from which they fell, the softness or hardness of the surface for landing, the rung of the ladder on which they had been standing, or the speed the car had been moving?”