The patient with fracture: the risk of subsequent fractures

This article reviews the available data considering the question of whether patients who have suffered one fragility fracture are at an increased risk of a subsequent fracture. A number of methodologic concerns are highlighted. There are also a relatively limited number of datasets available for consideration. There is, however, a consistent observation that patients who have had one fracture are at an increased risk of having subsequent fractures. The earlier the age at fracture and the greater the number of previous fractures, the greater the subsequent risk. Many recent population surveys on osteoporotic fracture have focused on screening populations for vertebral deformity as a useful population guide to osteoporotic fracture occurrence. The same conclusions apply to the risk of subsequent fractures. It is difficult to distinguish three possible hypotheses to explain this increased risk. First, and intuitively most likely, risk factors for the development of one fracture are still operative to increase susceptibility to a second and subsequent event. Second, the occurrence of a fracture, particularly in the limbs, is followed by bone loss, not completely reversible, which could lead to an increased risk of subsequent fracture. Finally, there may be mechanical influences caused by having had one fracture, and it may be these mechanical effects that increase this subsequent risk.