J Bone Miner Res. 2020 Jan 8. doi: 10.1002/jbmr.3953. [Epub ahead of print]
The term «fracture cascade» refers to the sequence of fragility fractures resulting from the increased fracture risk that occurs with aging and following fractures. Here, we evaluate the sequence of previous fractures in women aged 55-90 years presenting with a fragility fracture and subsequent (12-24 months) fracture incidence. In this retrospective, observational study, women aged 55-90 years with an «index» fragility fracture in 2013 were identified from Swedish national registries. A history of previous fractures (2001-2012) and osteoporosis treatment was used to characterize fracture cascade patterns. Cumulative incidence of new fractures within 12-24 months following the index fracture, based on index fracture type and age, were used to describe the risk of subsequent fractures. 35,146 women with a mean age of 73.8 years were included (7,180 hip, 2,786 clinical vertebral, and 25,180 non-hip/non-vertebral [NHNV] index fractures). 38% of women with hip, 38% with clinical vertebral, and 25% with NHNV index fractures had ≥1 previous fracture. Across all index fracture types, the proportion of women with any previous fracture increased with age; 34-46% of index hip or clinical vertebral fractures in women ≥70 years were not their first fracture. Following any index fracture, cumulative incidence of a new fracture over 24 months was over 11% (index clinical vertebral: 18%; index hip: 14%). Osteoporosis treatment rates were low both in patients with (27%) and without (18%) a previous fracture. These descriptive data demonstrate that almost one-third of women aged 55-90 years suffering a new fracture have had a previous fragility fracture. Fracture location influences incidence and type of subsequent fracture during the 24 months following a fragility fracture, with clinical vertebral fractures carrying the greatest imminent fracture risk. These data highlight the clinical impact and need for early, effective treatment soon after any fragility fracture.