Evidence map›Paper›PMID 30456571›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2019

Risk of subsequent fracture after prior fracture among older women.

A Balasubramanian, J Zhang, L Chen, D Wenkert, S G Daigle, A Grauer, J R Curtis

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 171 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
171citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

171 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Guideline
  2. Pooled it
  3. Pooled it
  4. Pooled it
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  6. The imminent risk of a fracture-existing worldwide data: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022
    Pooled it
  7. Guideline
  8. Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2020
    Pooled it
  9. Effectiveness of treatment initiation for secondary fracture prevention in the older population: Japanese Bone-fracture Osteoporosis in Late-stage population Database study (J-BOLD) - emulation of a randomized target trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Trial
  10. Romosozumab in patients who experienced an on-study fracture: post hoc analyses of the FRAME and ARCH phase 3 trials.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024
    Trial
  11. Risk factors for subsequent vertebral fracture after acute osteoporotic vertebral fractures.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2021
    Trial
  12. Trial
  13. Article
  14. Review
  15. The phenotype of pelvic and acetabular fractures in adults aged 50 and older: a national database analysis in the Netherlands.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Article
  16. Review
  17. Article
  18. Article
  19. Article
  20. Article

111 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

A BalasubramanianAmgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA. akhilab@amgen.com.
J ZhangUniversity of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294, USA.
L ChenUniversity of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294, USA.
D WenkertAmgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
S G DaigleUniversity of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294, USA.
A GrauerAmgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
J R CurtisUniversity of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Among 377,561 female Medicare beneficiaries who sustained a fracture, 10% had another fracture within 1 year, 18% within 2 years, and 31% within 5 years. Timely management to reduce risk of subsequent fracture is warranted following all nontraumatic fractures, including nonhip nonvertebral fractures, in older women.

introductionPrior fracture is a strong predictor of subsequent fracture; however, postfracture treatment rates are low. Quantifying imminent (12-24 month) risk of subsequent fracture in older women may clarify the need for early postfracture management.

methodsThis retrospective cohort study used Medicare administrative claims data. Women ≥ 65 years who sustained a clinical fracture (clinical vertebral and nonvertebral fracture; index date) and were continuously enrolled for 1-year pre-index and ≥ 1-year (≥  2 or ≥ 5 years for outcomes at those time points) post-index were included. Cumulative incidence of subsequent fracture was calculated from 30 days post-index to 1, 2, and 5 years post-index. For appendicular fractures, only those requiring hospitalization or surgical repair were counted. Death was considered a competing risk.

resultsAmong 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5 years post-index, respectively. Among women age 65-74 years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women ≥ 75 years regardless of initial fracture site (except ankle and tibia/fibula), 7-14% fractured again within 1 year depending on initial fracture site; risk rose to 15-26% within 2 years and 28-42% within 5 years. Risk of subsequent hip fracture exceeded 3% within 5 years in all women studied, except those < 75 years with an initial tibia/fibula or ankle fracture.

conclusionsWe observed a high and early risk of subsequent fracture following a broad array of initial fractures. Timely management with consideration of pharmacotherapy is warranted in older women following all fracture types evaluated.

Indexed as

AgedAged, 80 and overAge DistributionFemaleFollow-Up StudiesHip FracturesHumansIncidenceMedicareOsteoporosis, PostmenopausalOsteoporotic FracturesRecurrenceRetrospective StudiesRisk AssessmentSpinal FracturesTime FactorsEpidemiologyFractureFracture risk assessmentFragilityGeneral population studiesGeriatricIncidenceMajor osteoporotic fractureOsteoporosisPostmenopausalPrediction modelingPrevalenceRefracture

Identifiers

PMID30456571
PMCPMC6332293

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.