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Risk factors and incidence of repeat osteoporotic fractures among the elderly in Taiwan: a population-based cohort study.

Hsiao PC, Chen TJ, Li CY, Chu CM, Su TP, Wang SH, Pan HH, Wang KY - Medicine (Baltimore) (2015)

Bottom Line: ROF risk increased with age and Charlson Comorbidity Index (CCI) score.Greater risk for ROF was observed among female subjects and those who had suffered from hip and vertebral fracture at the first OF, had undergone OF-related surgery, and had received bone-related medications.The incidence of ROF in the Taiwanese elderly is higher during the first year after the initial OF, and ROF risk increases with age, female sex, high CCI score, and in those who have undergone OF-related surgery, sustained hip or vertebral fracture, and used bone-related medications.

View Article: PubMed Central - PubMed

Affiliation: From the Graduate Institute of Medical Sciences, National Defense Medical Center (PCH, HHP, KYW); Department of Nursing, Tri-Service General Hospital (PCH, HHP); Department of Family Medicine, Taipei Veterans General Hospital, Taipei (T-JC); Department of Public Health, National Cheng Kung University, Tainan (C-YL); Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University (C-MC); Department of Psychiatry, Taipei Veterans General Hospital (T-PS); Department of Orthopedics, Tri-Service General Hospital (SHW); Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (K-YW).

ABSTRACT
The incidence of osteoporotic fracture (OF), a condition that leads to higher morbidity and mortality in the elderly, is increasing yearly worldwide. However, most studies of OF have focused on the epidemiology of initial fractures, mainly in female and white populations. This study aimed to explore the incidence and the risk factors for repeat osteoporotic fracture (ROF) in Taiwan.We performed a retrospective cohort study using the Taiwan National Health Insurance Database (NHIRD) from 1995 through 2011. Individuals aged 65 years or older who experienced an initial OF were included. The patients were followed until death, the end of registration in the NHIRD, ROF occurrence, or the end of the study period (December 31, 2011), whichever occurred first. The incidence of ROF over ≥ 5 years after the initial fracture was analyzed, and the risk factors for ROF were assessed using Cox proportional hazards models. The incidence rates of ROF were 950.5, 321.4, 158.7, 92.8, and 70.2 per 1000 person-years among subjects in their first, second, third, fourth, and fifth years after the initial OF, respectively. Nearly 45% of the subjects sustained a ROF in the first year after OF. ROF risk increased with age and Charlson Comorbidity Index (CCI) score. Greater risk for ROF was observed among female subjects and those who had suffered from hip and vertebral fracture at the first OF, had undergone OF-related surgery, and had received bone-related medications. The incidence of ROF in the Taiwanese elderly is higher during the first year after the initial OF, and ROF risk increases with age, female sex, high CCI score, and in those who have undergone OF-related surgery, sustained hip or vertebral fracture, and used bone-related medications.

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Cumulative incidence of ROF among different age groups. OF = osteoporotic fracture, ROF = repeat osteoporotic fracture.
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Figure 2: Cumulative incidence of ROF among different age groups. OF = osteoporotic fracture, ROF = repeat osteoporotic fracture.

Mentions: Table 3 shows the analyses of the predictive factors for ROF in subjects with first-time OF. Factors with P values ≦0.05 in the Cox univariate proportional hazard model were entered into the Cox multivariate proportional hazard model to ascertain the hazard ratio (HR) of each factor and the risk factors for ROF. Elderly individuals aged ≥85 years showed a higher ROF risk than subjects between 65 and74 years of age (HR = 1.26, 95% confidence interval [CI] 1.18–1.34, P < 0.001). Figure 2 shows the Kaplan–Meier estimates of the cumulative overall ROF incidence among different age groups. The cumulative ROF incidence rates significantly differed among the various age groups (log-rank P < 0.001). Females were more likely to sustain ROF than males (HR = 1.41, 95% CI 1.35–1.47, P < 0.001). The vertebrae and the hip were the most common ROF locations, and the risk of fracture of the vertebrae and hip was higher than that of the trunk, with ROF HRs of 1.59 (95% CI 1.49–1.70, P < 0.001) and 1.45 (95% CI 1.34–1.57, P < 0.001), respectively. Figure 3 shows the Kaplan–Meier estimates of the cumulative overall ROF incidence among the different OF locations. The cumulative ROF incidence rates significantly differed among the various OF locations (log-rank P < 0.001). Moreover, elderly subjects who underwent OF-related surgery and were chronic users of bone-related medications were more likely to sustain ROF, with HRs of 1.35 (95% CI 1.29–1.41, P < 0.001) and 1.11 (95% CI 1.07–1.15, P < 0.001), respectively. Elderly subjects with a CCI score ≥3 were also more likely to sustain ROF than subjects with a CCI score = 0 (HR = 1.19, 95% CI 1.12–1.26, P < 0.001). Figure 4 shows the Kaplan–Meier estimates of the cumulative overall ROF incidence for different values of the CCI. The cumulative ROF incidence rates significantly differed among the various CCI groups (log-rank P < 0.001).


Risk factors and incidence of repeat osteoporotic fractures among the elderly in Taiwan: a population-based cohort study.

Hsiao PC, Chen TJ, Li CY, Chu CM, Su TP, Wang SH, Pan HH, Wang KY - Medicine (Baltimore) (2015)

Cumulative incidence of ROF among different age groups. OF = osteoporotic fracture, ROF = repeat osteoporotic fracture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554188&req=5

Figure 2: Cumulative incidence of ROF among different age groups. OF = osteoporotic fracture, ROF = repeat osteoporotic fracture.
Mentions: Table 3 shows the analyses of the predictive factors for ROF in subjects with first-time OF. Factors with P values ≦0.05 in the Cox univariate proportional hazard model were entered into the Cox multivariate proportional hazard model to ascertain the hazard ratio (HR) of each factor and the risk factors for ROF. Elderly individuals aged ≥85 years showed a higher ROF risk than subjects between 65 and74 years of age (HR = 1.26, 95% confidence interval [CI] 1.18–1.34, P < 0.001). Figure 2 shows the Kaplan–Meier estimates of the cumulative overall ROF incidence among different age groups. The cumulative ROF incidence rates significantly differed among the various age groups (log-rank P < 0.001). Females were more likely to sustain ROF than males (HR = 1.41, 95% CI 1.35–1.47, P < 0.001). The vertebrae and the hip were the most common ROF locations, and the risk of fracture of the vertebrae and hip was higher than that of the trunk, with ROF HRs of 1.59 (95% CI 1.49–1.70, P < 0.001) and 1.45 (95% CI 1.34–1.57, P < 0.001), respectively. Figure 3 shows the Kaplan–Meier estimates of the cumulative overall ROF incidence among the different OF locations. The cumulative ROF incidence rates significantly differed among the various OF locations (log-rank P < 0.001). Moreover, elderly subjects who underwent OF-related surgery and were chronic users of bone-related medications were more likely to sustain ROF, with HRs of 1.35 (95% CI 1.29–1.41, P < 0.001) and 1.11 (95% CI 1.07–1.15, P < 0.001), respectively. Elderly subjects with a CCI score ≥3 were also more likely to sustain ROF than subjects with a CCI score = 0 (HR = 1.19, 95% CI 1.12–1.26, P < 0.001). Figure 4 shows the Kaplan–Meier estimates of the cumulative overall ROF incidence for different values of the CCI. The cumulative ROF incidence rates significantly differed among the various CCI groups (log-rank P < 0.001).

Bottom Line: ROF risk increased with age and Charlson Comorbidity Index (CCI) score.Greater risk for ROF was observed among female subjects and those who had suffered from hip and vertebral fracture at the first OF, had undergone OF-related surgery, and had received bone-related medications.The incidence of ROF in the Taiwanese elderly is higher during the first year after the initial OF, and ROF risk increases with age, female sex, high CCI score, and in those who have undergone OF-related surgery, sustained hip or vertebral fracture, and used bone-related medications.

View Article: PubMed Central - PubMed

Affiliation: From the Graduate Institute of Medical Sciences, National Defense Medical Center (PCH, HHP, KYW); Department of Nursing, Tri-Service General Hospital (PCH, HHP); Department of Family Medicine, Taipei Veterans General Hospital, Taipei (T-JC); Department of Public Health, National Cheng Kung University, Tainan (C-YL); Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University (C-MC); Department of Psychiatry, Taipei Veterans General Hospital (T-PS); Department of Orthopedics, Tri-Service General Hospital (SHW); Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan (K-YW).

ABSTRACT
The incidence of osteoporotic fracture (OF), a condition that leads to higher morbidity and mortality in the elderly, is increasing yearly worldwide. However, most studies of OF have focused on the epidemiology of initial fractures, mainly in female and white populations. This study aimed to explore the incidence and the risk factors for repeat osteoporotic fracture (ROF) in Taiwan.We performed a retrospective cohort study using the Taiwan National Health Insurance Database (NHIRD) from 1995 through 2011. Individuals aged 65 years or older who experienced an initial OF were included. The patients were followed until death, the end of registration in the NHIRD, ROF occurrence, or the end of the study period (December 31, 2011), whichever occurred first. The incidence of ROF over ≥ 5 years after the initial fracture was analyzed, and the risk factors for ROF were assessed using Cox proportional hazards models. The incidence rates of ROF were 950.5, 321.4, 158.7, 92.8, and 70.2 per 1000 person-years among subjects in their first, second, third, fourth, and fifth years after the initial OF, respectively. Nearly 45% of the subjects sustained a ROF in the first year after OF. ROF risk increased with age and Charlson Comorbidity Index (CCI) score. Greater risk for ROF was observed among female subjects and those who had suffered from hip and vertebral fracture at the first OF, had undergone OF-related surgery, and had received bone-related medications. The incidence of ROF in the Taiwanese elderly is higher during the first year after the initial OF, and ROF risk increases with age, female sex, high CCI score, and in those who have undergone OF-related surgery, sustained hip or vertebral fracture, and used bone-related medications.

Show MeSH
Related in: MedlinePlus