Second Osteoporotic Fractures Are Common After Index Fractures

With the rate of a second fracture in high-risk patients still unknown, researchers evaluated the recurrence of fx in certain vulnerable subgroups.

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Second osteoporotic fractures are common following index fractures, particularly among older individuals and those who have index spine fractures or chronic conditions that increase their risk, according to study results presented at the American Association of Clinical Endocrinology annual meeting, held online from May 26 to May 29, 2021.

To evaluate the percentage of individuals with a second fracture, the study researchers assessed the site of the index fracture among specific subgroups chosen for potential extra risk. These populations included women; persons older than 65 years; those older than 80 years; and individuals with type 2 diabetes mellitus, osteoarthritis, rheumatoid arthritis, or respiratory diseases.

Assessment for the second fracture began on the index fracture date and varied by the availability of data.

This retrospective cohort study included 755,312 individuals from Symphony Health PatientSource® (mean age 70.2±9.4 years; 69.9% aged 65 years or older; 71.6% women; type 2 diabetes mellitus, 28.9%; respiratory disease, 26.3%; rheumatoid arthritis, 4.6%; osteoarthritis, 27.4%; mean follow-up 23.8±6.7 months).

The date of the fracture during the period from May 2017 to March 2019 was designated as the index. The claims-based algorithm used to identify case qualifying fractures was validated previously.

Among the study population, 13.6% (n=102,359) of those who experienced an initial fracture also experienced a second fracture: 10.1% radius/ulna, 10.9% ankle, 11.0% carpal/wrist, 12.3% shoulder, 12.3% tibia/fibula, 15.9% hip, 17.6% other femur, 18.4% clinical spine, and 18.7% pelvis.

Second fractures at the same site occurred in the following percentages: 2.4% carpal/wrist, 3.3% ankle, 3.4% radius/ulna, 4.6% pelvis, 5.4% shoulder, 5.4% tibia/fibula, 6.3% femur, 6.9% hip, and 12.0% clinical spine.

After subgroup analysis, researchers revealed secondary fracture rates across fracture sites that were similar to those of the entire study population. However, certain subgroups experienced higher second fracture rates: age older than 80 years, 17.3%; rheumatoid arthritis, 17.2%; osteoarthritis, 16.2%; respiratory disease, 15.4%; type 2 diabetes mellitus, 14.9%; age older than 65 years, 14.8%; and women, 14.1%.

The study researchers concluded that “a high proportion of [patients] have a second [fracture] following their index [fracture].” Furthermore, “the proportion is higher for older [patients], those with index clinical spine [fractures], and those with chronic conditions associated with increased [fracture] risk and healing.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Singer AJ, Williams SA, Weiss RJ, Wang Y, Nichols H, Pyrih N. The evaluation of fractures following a fragility fracture in real-world setting. Poster presented at: AACE Envision 2021; May 26-29, 2021; virtual.