Evaluating Subsequent Fracture Risk in Aging Women with Traumatic Fractures

Patrick Campbell

An analysis of data from the Women's Health Initiative provides an overview of the risk of subsequent fracture seen among women with a history of traumatic versus nontraumatic fracture in postmenopausal women.

Using data from the Women’s Health Initiative Study, new research indicates any fracture among aging women was associated with greater risk of subsequent fracture—suggesting osteoporosis assessment should include both traumatic and nontraumatic fractures.

Analysis of more than 65,000 women followed for an average of 8 years, results demonstrated that while women with nontraumatic fracture were still at a greater risk of subsequent fracture compared to their counterparts with traumatic fractures, those with traumatic fracture were still at a 25% increased risk of subsequent fractures.

“This study’s findings suggest that all fractures, whether traumatic or nontraumatic, should warrant evaluation for osteoporosis (including BMD testing) and counseling regarding subsequent increased fracture risk. 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,” wrote investigators.

With fractures posing a significant burden to the health and well-being of patients, particularly aging women, a team of clinicians from multiple institutions across the US designed the current study as a prospective observational study of data from women enrolled in the WHI study between September 1994 and December 1998. Containing data related to more than 160,000 women aged 50-79 years from across the US, WHI provided investigators with a cohort sample of 75,335 patients with an incident fracture for inclusion their analyses.

After exclusion of those with no follow-up for incident fracture and those missing covariates data, 66,874 patients with a mean follow-up of 8.1 (SD, 1.6) years were identified for inclusion in the final analytical sample. Of these, 7142 experienced an incident fracture event during the study period. When assessing fractures, 1624 were considered traumatic, 3891 were considered nontraumatic, and 1627 were considered of unknown trauma.

In adjusted analyses, risk of subsequent fracture was 49% greater after initial fracture (aHR, 1.49; 95% CI, 1.38-1.61). Among women with a traumatic fracture, the risk of experiencing a subsequent fracture was 25% greater (aHR, 1.25; 95% CI, 1.06-1.48; P=.01) and this risk was 52% greater among women with a nontraumatic fracture (HR, 1.52; 95% CI, 1.37-1.68; P <.001) when compared to those with no fracture history. Further analysis indicated experiencing a traumatic fracture was not associated with a significantly increased risk of experiencing a subsequent fracture when compared to those who experienced a nontraumatic fracture (aHR, 0.82; 95% CI,0.68-1.00; P=.05).

In an editorial comment, Anne Schafer, MD, and Dolores Shoback, MD, both of UCSF, wrote the findings from this study help underline the importance of treating bone health in fracture patients.

“The idea that nontraumatic vs traumatic is a distinction without a difference will likely be welcomed by busy clinicians. 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?,” wrote the pair.

This study, “Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures,” was published in JAMA Internal Medicine.