Acute and long-term increase in fracture risk after hospitalization for vertebral fracture

The aims of this study were to determine the magnitude of the increase in r isk of further fracture following hospitalization for vertebral fracture, a nd in particular to determine the time course of this risk. The records of the Swedish Patient Register were examined from 1987 to 1994 to identify al l patients who were admitted to hospital for thoracic or lumbar vertebral f ractures. Vertebral fractures were characterized as due to high- or low-ene rgy trauma. Patients were followed for subsequent hospitalizations for hip fracture, and for all fractures combined. A Poisson model was used to deter mine the absolute risk of subsequent nonvertebral fracture and compared wit h that of the general population. We analyzed 13.4 million hospital admissi ons from which 28 869 individuals with vertebral fracture were identified, of which 60% were associated with low-energy trauma. There was a marked inc rease in subsequent incidence of hip and all fractures within the first yea r following hospitalization for vertebral fracture in both men and women. T hereafter, fracture incidence declined toward, but did not attain, baseline risk. Increased risks were particularly marked in the young. The increase in fracture risk was more marked following low-energy vertebral fracture th an in the case of high-energy trauma. We conclude that the high incidence o f new fractures within a year of hospitalization for vertebral fractures, i rrespective of the degree of trauma involved, indicates that such patients should be preferentially targeted for treatment. It is speculated that shor t courses of treatment at the time of first vertebral fracture could provid e important therapeutic dividends.