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Fractures in women should be taken seriously.

24 May 2021

It is well known that women having a low trauma fracture (eg fracture from falling from standing height) should be assessed for risk of osteoporosis and hence further fracture. A study recently reported in the Lancet assessed subsequent fractures after initial fracture in Women's Health Initiative (1993-2018) participants who provided follow-up for a mean of 15.4 years. Data was examined for 157,282 participants; baseline age 50-79; of which 47,458 participants had incident fracture.

The study has found that in postmenopausal women, every type of initial fracture (lower arm or wrist, upper arm or shoulder, upper leg, knee, lower leg, ankle, and hip or pelvis fracture) is associated with significantly increased risk of subsequent fracture. The higher risk of subsequent fracture after initial fracture was evident in all age groups, even younger postmenopausal women aged 50 to 59 years.

Risks of subsequent fracture were more pronounced among non-Hispanic Black, Hispanic/Latina, and Asian/Pacific Islander than among non-Hispanic White women.

The authors concluded that women who experience any of these fractures should be targeted for interventions to prevent subsequent fractures.

Osteoporotic fractures pose a huge burden on individuals in terms of pain, reduced functioning, and increased mortality, as well as on healthcare services. Many regions in the UK have a fracture liaison service which aims to identify women with fracture, assess risk of future fracture and offer interventions, but not all women are identified. This further report should increase awareness among clinicians that initial fractures of any type in postmenopausal women, even at sites other than the hip, vertebra, or wrist, should trigger counselling regarding increased subsequent fracture risk. Women of all ages, including younger women aged 50 to 59 years, who have initial fracture should be counselled that they are elevated risk of subsequent fracture. We also hope that women will ask for further information if they suffer from a fracture at any site. In addition, future research should examine potential reasons for the identified racial/ethnic differences.

See more about osteoporosis at Late Menopausal Symptoms Osteoporosis: Menopause Matters

Reference: After the initial fracture in postmenopausal women, where do subsequent fractures occur? Crandall J, Hunt P, LaCroix A et al. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00106-1/fulltext

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