Fractures may herald more breaks in future

X-ray shows a complete fracture of the humeral neck.
X-ray shows a complete fracture of the humeral neck.
Research shows that women who sustained a proximal humeral fracture were more than five times as likely to break a hip within a year as women whose bones were intact. The association was so strong that investigators deemed it an independent risk factor for hip fractures (J Bone Joint Surg Am. 2009;91:503-511).

The data came from a cohort of 8,049 white women aged 65 years or older with no history of hip
or humeral fracture. They were followed for a mean of 9.8 years, and those who did not break an arm or hip comprised the reference group.

Of the 322 women who sustained a proximal humeral fracture, 44 (13.7%) later broke a hip. The risk of subsequent hip fracture was highest within one year after the shoulder injury, with a hazard ratio (HR) of 5.68. The association dropped sharply, with HRs of 0.87 between one and five years and 0.58 after five years.

“The most dangerous time is within one year of a proximal humeral fracture, and therefore intervention should be initiated without delay,” the researchers conclude. “This small window of time provides an opportunity that may decrease the risk of subsequent hip fractures.” Suggested interventions include starting oral bisphosphonate or other medication and installing safety devices at home.

These results coincide with an Australian study which found that any low-trauma fracture raised mortality risks for both men and women for 5-10 years. Subsequent fractures occurred within five years among 30% of the women and 22% of the men, raising their mortality risk for an additional five years (JAMA. 2009;301:513-521).

“Given these findings, more attention should be given to nonhip, nonvertebral fractures that constituted approximately 50% of all low-trauma fractures,” the researchers recommend. “These data suggest fracture is a signal event that heralds increased mortality risk.”
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