1. Epidemiology and Global Health
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Epidemiological transition to mortality and re-fracture following an initial fracture

  1. Thao Phuong Ho-Le  Is a corresponding author
  2. Thach Son Tran
  3. Dana Bliuc
  4. Hanh M Pham
  5. Steven A Frost
  6. Jacqueline R Center
  7. John A Eisman
  8. Tuan V Nguyen  Is a corresponding author
  1. Garvan Institute of Medical Research, Australia
  2. Andrology and Fertility Hospital of Hanoi, Viet Nam
Research Article
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Cite this article as: eLife 2021;10:e61142 doi: 10.7554/eLife.61142

Abstract

This study sought to redefine the concept of fracture risk that includes refracture and mortality. We analysed data obtained from 2046 women and 1205 men aged 60+ years, whose health status, including bone mineral density (BMD), has been monitored. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%, n=229) than in men (22%, n=41), but mortality risk was higher in men (41%, n=75) than in women (25%, n=156). Key predictors of subsequent fracture risk included advancing age (hazard ratio [HR] 1.17; 95%CI, 1.08-1.26) and low BMD (HR 1.41; 1.23-1.61). Predictors of mortality were male gender (HR 2.4; 1.79-3.21), advancing age (1.67; 1.53-1.83), and lower femoral neck BMD (1.16; 1.01-1.33). These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions.

Article and author information

Author details

  1. Thao Phuong Ho-Le

    Healthy Aging Theme, Garvan Institute of Medical Research, Sydney, Australia
    For correspondence
    t.ho-le@garvan.org.au
    Competing interests
    Thao Phuong Ho-Le, received the Christine & T. Jack Martin Research travel grant from AMGEN & Australian and New Zealand Bone and Mineral Society..
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-8387-1893
  2. Thach Son Tran

    Healthy Aging Theme, Garvan Institute of Medical Research, Sydney, Australia
    Competing interests
    No competing interests declared.
  3. Dana Bliuc

    Healthy Aging Theme, Garvan Institute of Medical Research, Sydney, Australia
    Competing interests
    No competing interests declared.
  4. Hanh M Pham

    Fertility Department, Andrology and Fertility Hospital of Hanoi, Hanoi, Viet Nam
    Competing interests
    No competing interests declared.
  5. Steven A Frost

    Healthy Aging Theme, Garvan Institute of Medical Research, Sydney, Australia
    Competing interests
    No competing interests declared.
  6. Jacqueline R Center

    Healthy Aging Theme, Garvan Institute of Medical Research, Sydney, Australia
    Competing interests
    Jacqueline R Center, has given educational talks for and received travel expenses from Amgen, Merck Sharp & Dohme, Novartis, Sanofi-Aventis. She has received travel expenses from Merck Sharp & Dohme, Amgen and Aspen..
  7. John A Eisman

    Healthy Aging Theme, Garvan Institute of Medical Research, Sydney, Australia
    Competing interests
    John A Eisman, has served as consultant on Scientific Advisory Boards for Amgen, 35 Eli Lilly, Merck Sharp & Dohme, Novartis, Sanofi-Aventis, Servier and deCode..
  8. Tuan V Nguyen

    Healthy Aging Theme, Garvan Institute of Medical Research, Sydney, Australia
    For correspondence
    t.nguyen@garvan.org.au
    Competing interests
    Tuan V Nguyen, has received honoraria for consulting and speaking in symposia sponsored by Merck Sharp & Dohme, Roche, Sanofi-Aventis, Novartis, and Bridge Healthcare Pty Ltd (Vietnam)..

Funding

National Health and Medical Research Council (The Australian National Health and Medical Research Council grant,NHMRC 276413)

  • Tuan V Nguyen

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: The study was approved by the Ethics Committee of St Vincent's Hospital (Sydney) (HREC reference number: 13/254) and carried out according to the Australian National Health and Medical Research Council (NHMRC) Guidelines, consistent with the Declaration of Helsinki (established in 1964 and revised in 1989) (US Food and Drug Administration). All participants have provided written informed consent.

Reviewing Editor

  1. Dolores Shoback, University of California, San Francisco, United States

Publication history

  1. Received: July 16, 2020
  2. Accepted: January 25, 2021
  3. Accepted Manuscript published: February 9, 2021 (version 1)

Copyright

© 2021, Ho-Le et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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