The Risk of Osteoporotic Refracture

Osteoporotic fracture is a growing public health problem worldwide. Because of the ageing of most populations, the number of people who will sustain a fracture is predicted to increase significantly over the next few decades. This chapter reviews the epidemiology of osteoporotic fracture and its outcomes, including subsequent fracture and associated premature mortality. All osteoporotic fractures are associated with an approximate twofold increased risk of a subsequent fracture, with the greatest risk of refracture occurring close in time to the initial fracture. This risk is higher in men than in women. Although hip and vertebral fractures are considered the most serious of fracture types, nonhip nonvertebral fractures account for more than 50% of initial and subsequent fractures. In addition, all proximal fractures are associated with an increased mortality risk, which is highest close to the fracture event and persists for at least 5 years before declining to the background population mortality rate. A subsequent fracture further increases this risk. Antiresorptive medication may be associated with improved survival in those at fracture risk. It is now clear that osteoporotic fracture is associated with poor outcomes, and early intervention is essential to reduce the subsequent fracture and possibly also mortality risk.