Risk factors for secondary fractures in postmenopausal osteoporosis: A retrospective study

Osteoporosis, the most common metabolic bone disease, leads to fragility fractures that cause acute pain, functional impairment, and disability, premature mortality. Although risk factors for initial fractures in postmenopausal women with osteoporosis are well-documented in previous studies, predictors of secondary fractures have not been thoroughly investigated. This study aimed to investigate risk factors for secondary fractures in postmenopausal osteoporosis patients. We conducted a retrospective study of patients with postmenopausal osteoporosis-related fractures admitted to Hunan Aerospace Hospital between January 2018 and December 2023. Participants were divided into the case group (patients with secondary fractures) and the control group (patients with a single primary fracture event). The incidence of fractures peaked during the winter season (29.8%), with the vertebral body being the most commonly affected site (80.4%). We collected comprehensive patient data, including demographic and clinical characteristics, laboratory measurements, comorbidities, lifestyle factors, and treatment data. Multivariate logistic regression was performed to identify independent risk factors among variables showing significant association (P < .05) in univariate analyses. Age, body mass index (BMI), bone mineral density (BMD) T-score, hemoglobin levels, diabetes, ophthalmic diseases, prior surgical history, and basic treatment were chosen for inclusion in the multivariate logistic regression model. And 4 independent factors were associated with secondary fractures: low BMI (OR = 0.726, 95% CI: 0.618-0.953; P = .018), reduced BMD T-score (OR = 0.441, 95% CI: 0.218-0.770; P = .005), diabetes (OR = 3.312, 95% CI: 1.097-9.992; P = .032), and ophthalmic diseases (OR = 7.365, 95% CI: 1.156-45.535; P = .033). Our study highlights the combined association of metabolic factors (low BMI, diabetes), skeletal fragility (reduced BMD), and visual impairment (ophthalmic diseases) with secondary fracture risk in postmenopausal women. The identification of these modifiable risk factors may be important in developing strategies to improve patients' quality of life and reduce secondary fracture incidence and healthcare burdens in the future.