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Robert Lindsay, MD,PhD; Stuart L. Silverman, MD; Cyrus Cooper, MD; David A. Hanley, MD; Ian Barton, BSc; Susan B. Broy, MD; Angelo Licata, MD,PhD; Laurent Benhamou, MD; Piet Geusens, MD; Kirsten Flowers, BS; Hilmar Stracke, MD,PhD; Ego Seeman, MD

JAMA. 2001;285:320-323.

Context  Vertebral fractures significantly increase lifetime risk of future fractures, but risk of further vertebral fractures in the period immediately following a vertebral fracture has not been evaluated.

Objective  To determine the incidence of further vertebral fracture in the year following a vertebral fracture.

Design and Setting  Analysis of data from 4 large 3-year osteoporosis treatment trials conducted at 373 study centers in North America, Europe, Australia, and New Zealand from November 1993 to April 1998.

Subjects  Postmenopausal women who had been randomized to a placebo group and for whom vertebral fracture status was known at entry (n = 2725).

Main Outcome Measure  Occurrence of radiographically identified vertebral fracture during the year following an incident vertebral fracture.

Results  Subjects were a mean age of 74 years and had a mean of 28 years since menopause. The cumulative incidence of new vertebral fractures in the first year was 6.6%. Presence of 1 or more vertebral fractures at baseline increased risk of sustaining a vertebral fracture by 5-fold during the initial year of the study compared with the incidence in subjects without prevalent vertebral fractures at baseline (relative risk [RR], 5.1; 95% confidence interval [CI], 3.1-8.4; P<.001). Among the 381 participants who developed an incident vertebral fracture, the incidence of a new vertebral fracture in the subsequent year was 19.2% (95% CI, 13.6%-24.8%). This risk was also increased in the presence of prevalent vertebral fractures (RR, 9.3; 95% CI, 1.2-71.6; P = .03).

Conclusion  Our data indicate that women who develop a vertebral fracture are at substantial risk for additional fracture within the next year.

Author Affiliations: Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY (Dr Lindsay); Osteoporosis Medical Center, Cedars Sinai Medical Center, and Greater Los Angeles VA Health System, Los Angeles, Calif (Dr Silverman); Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton, England (Dr Cooper); University of Calgary Health Sciences Centre, Calgary, Alberta (Dr Hanley); Procter & Gamble Pharmaceuticals, Staines, Middlesex, England (Mr Barton); Center for Arthritis and Osteoporosis, Illinois Bone and Joint Institute, Des Plaines (Dr Broy); Cleveland Clinic Foundation, Cleveland, Ohio (Dr Licata); Centre Hospitalier d'Orleans, Orleans, France (Dr Benhamou); Limburg University Center, Diepenbeek, Belgium (Dr Geusens); University of Maastricht, the Netherlands (Dr Geusens); Procter & Gamble Pharmaceuticals, Cincinnati, Ohio (Ms Flowers); Justus-Liebig University, Giessen, Germany (Dr Stracke); and University of Melbourne, Melbourne, Australia (Dr Seeman).

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