Publications

Abstract

CONTEXT: Half of fragility fractures occur in individuals with non-osteoporotic BMD (BMD T-score >-2.5), however there is no information on post-fracture adverse events of subsequent fracture and mortality for different BMD levels. OBJECTIVES: To determine the risk and predictors of subsequent fracture and excess mortality following initial fracture according to BMD. DESIGN: Community dwelling participants aged 60+ from Dubbo Osteoporosis Epidemiology Study with incident fractures followed from1989-2011. OUTCOME MEASUREMENTS: Risk of subsequent fracture and mortality according to BMD categorised as normal (T-score <-1), osteopenia (T-score</= -1 and > -2.5) and osteoporosis (T-score </=-2.5). RESULTS: There were 528 low-trauma fractures in women and 187 in men. Of these, 12% occurred in individuals with normal BMD (38 women, 50 men) and 42% in individuals with osteopenia (221 women, 76 men). The RR of subsequent fracture was >2.0 fold for all levels of BMD (normal BMD: 2.0 (1.2- 3.3) for women and 2.1 (1.2- 3.8) for men, osteopenia: 2.1 (1.7- 2.6) for women and 2.5 (1.6- 4.1) for men and osteoporosis 3.2 (2.7- 3.9) for women and 2.1 (1.4- 3.1) for men. The likelihood of falling and reduced quadriceps strength contributed to subsequent fracture risk in women with normal BMD. By contrast with subsequent fracture risk, post-fracture mortality was increased particularly in individuals with low BMD [age-adjusted SMR for osteopenia 1.3 (1.1- 1.7) and 2.2 (1.7- 2.9) for women and men, respectively and osteoporosis 1.7 (1.5- 2.0) and 2.7 (2,0- 3.6) for women and men, respectively]. CONCLUSION: This study demonstrates the high burden of subsequent fracture in individuals with normal BMD and osteopenia, and excess mortality particularly for those with osteopenia (and osteoporosis). These findings highlight the importance of these fractures and underscore the gap in evidence for benefit of anti-osteoporotic treatment for fragility fracture, in those with only mildly low BMD. (c) 2014 American Society for Bone and Mineral Research.