2nd Fracture Risk Same in Men as Women

Men who have had one osteoporosis-related fracture are just as likely as women to suffer a second, new research shows.

In fact, in the Australian study, men had a somewhat higher risk than women of having a second fracture -- 60% vs. 40%.

The researchers point out that both sexes have a very high risk for subsequent fractures once a first fracture related to bone weakening has occurred.

The results highlight the need for treatment, regardless of sex, they say.

Studies suggest that fewer than one in three postmenopausal women and one in 10 men with prior fractures take osteoporosis drugs after their break.

The new study is published in the Jan. 24/31 issue of The Journal of the American Medical Association.

"While women are initially twice as likely as men to have a fracture, once the first break occurs, the risk of a second substantially increases and the protective effects of being male disappear altogether," study researcher Jacqueline Center, MBBS, PhD, says in a news release.

"Anyone, a man or a woman, over 50 years of age, with a fracture of any kind resulting from minimal injury, such as a slip on the pavement, needs to be investigated and treated for osteoporosis," she says.

44 Million Americans at Risk

Ten million Americans have osteoporosis, and 34 million have low bone mass, which puts them at high risk for the disease, according to figures from the National Osteoporosis Foundation.

One in two women and one in four men over the age of 50 will experience an osteoporosis-related fracture during the remainder of their lifetime.

Though much is known about the risks associated with a first fracture, little research has been done on second fractures. And almost all the studies have been done in women.

The study reported by Center and her colleagues from Sydney, Australia's Garvan Institute of Medical Research is one of the first long-term, follow-up studies examining second fractures to include both men and women.

The study initially included roughly 3,000 Australian men and women 60 and older followed for 16 years -- from 1989 until 2005.

A total of 905 women and 337 men experienced at least one osteoporosis-related fracture during that time; and 253 women and 71 men had a subsequent fracture.

The risk of having a second fracture was found to be similar for women and men. Within 10 years of experiencing a first fracture, 40% of surviving women in the study and 60% of surviving men had a second fracture.

The highest risks were seen among people who had experienced hip and spinal fractures. The most common sites of fractures related to bone weakening are the hips, spine, wrist, and ribs.
Treatment Rates Still Low

The Australian study did not examine the impact of osteoporosis treatment on fracture rates. But previous research suggests that such treatment can reduce the risk of a second fracture by half, Center says.

Greater use of osteoporosis drugs could have a huge impact on the at-risk elderly population, rheumatologist and epidemiologist Daniel Solomon, MD, MPH, of Boston's Brigham and Women's Hospital, tells WebMD.

"About 50% of people who have hip fractures lose their independence as a result, and many of them end up in nursing homes," Solomon says.

Three years ago, Solomon and colleagues reported that as few as one in five people who had had osteoporosis-related hip or wrist fractures received treatment to help prevent future fractures.

Their latest analysis suggests that more high-risk patients are being treated, but Solomon says treatment rates are still far too low.

Now, only about 30% of patients are started on osteoporosis drugs after suffering a hip fracture related to bone weakening, and only about one in 10 hip fracture patients in nursing homes receive treatment, he says.

"Virtually every guideline says that people who have had an [osteoporosis-related] fracture should b on treatment, but, for whatever reason, that isn't happening," he says.

"It doesn't make sense because these treatments work," says Solomon. "They reduce future fractures and can have a big impact on morbidity and mortality."

SOURCES: Center, J. The Journal of the American Medical Association, Jan. 24/31, 2007; vol 297: pp 387-394. Jacqueline R. Center, MBBS, PhD, and John A. Eisman, MBBS, PhD, Bone and Mineral Research Program, Garvan Institute of Medical Research, Sydney, Australia. Daniel Solomon, MD, MPH, rheumatologist and epidemiologist, Brigham and Women's Hospital, Boston. National Osteoporosis Foundation: "Osteoporosis Fast Facts."