Oral Presentation 30th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2020

Background and Objective. A fragility fracture can lead to reduced life expectancy. There is, however, a large variation between individuals in terms of adverse health states following a fracture. This study sought to define the pattern of, and determinants for, the transition between fracture, re-fracture, and mortality.

Methods. This cohort study involved 2046 women and 1205 men aged 60+, whose fracture status and health outcomes had been continuously monitored for up to 20 years. Fragility fractures were ascertained using X-ray report. The incidence of mortality was ascertained from the state birth, death and marriage registry. Femoral neck bone mineral density (FNBMD, GE-Lunar Prodigy) was measured at baseline. The transition probabilities and time between no fracture, initial fracture, second fracture, third fracture, and mortality were estimated using multi-state model.

Results. The average age at baseline of 2046 women and 1205 men was 70 years. During the [average] 10 years of follow-up, 31% (n=632) women and 15% (n=184) men had sustained a first fracture. Among those with the first fracture, the risk of sustaining a second fracture was 36% in women and 22% in men, and the risk of mortality was 25% in women and 41% in men. Key predictors of subsequent fracture risk included advancing age (HR 1.17; 95%CI, 1.08 to 1.26) and low BMD (1.41; 1.23 to 1.61). Predictors of fracture-associated mortality were male gender (HR 2.4; 95%CI, 1.79 to 3.21), age (1.67; 1.53 to 1.83), and femoral neck BMD (1.16; 1.01 to 1.33).

Conclusion. Individuals with an initial fracture have an increased risk of subsequent fractures and mortality, and the risk of fracture-associated mortality in men is greater than in women. The risks could be predicted by age and bone density. These results can aid patients and doctors make evidence-based treatment decisions.