Ann Rheum Dis 68:99-102 doi:10.1136/ard.2008.092775
  • Clinical and epidemiological research

Clinical subsequent fractures cluster in time after first fractures

  1. T A C M van Geel1,
  2. S van Helden2,
  3. P P Geusens3,4,
  4. B Winkens5,
  5. G-J Dinant1
  1. 1
    Department of General Practice, Maastricht University, Maastricht, The Netherlands
  2. 2
    Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
  3. 3
    Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
  4. 4
    Biomedical Research Institute, University Hasselt, Hasselt, Belgium
  5. 5
    Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
  1. T van Geel, Maastricht University, Department of General Practice, PO Box 616, 6200 MD, Maastricht, The Netherlands; t.vangeel{at}
  • Accepted 26 July 2008
  • Published Online First 3 August 2008


Objectives: The risk of subsequent fractures is double the risk of having a first fracture. We analysed whether this risk is constant or not over time.

Methods: A population-based study in 4140 postmenopausal women, aged between 50 and 90 years, on radiographic confirmed clinical fractures from menopause onwards analysed by Cox regression.

Results: A total of 924 (22%) women had a first fracture and 243 (26% of 924) a subsequent fracture. Of all first fractures, 4% occurred in each year from menopause onwards, while after a first fracture 23% of all subsequent fractures occurred within 1 year and 54% within 5 years.

When calculated from time of first fracture, the relative risk (RR) of subsequent fracture was 2.1 (95% CI 1.7 to 2.6) and remained increased over 15 years. When calculated for specific time intervals after a first fracture, the RR was 5.3 (95% CI 4.0 to 6.6) within 1 year, 2.8 (95% CI 2.0 to 3.6) within 2–5 years, 1.4 (95% CI 1.0 to 1.8) within 6–10 years and 0.41 (95% CI 0.29 to 0.53) after >10 years.

Conclusions: From menopause onwards, clinical fractures cluster in time, indicating the need for early action to prevent subsequent fractures.


  • Competing interests: None.

  • Funding: This project was supported by grants from the Maastricht University School for Public Health and Primary Care (Caphri).

  • Ethics approval: The Medical Ethics Committee of Maastricht University and the Maastricht University Hospital approved the study (reference no. MEC 94–196.1).