Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; Swinburne University of Technology, Melbourne, Australia; Faculty of Engineering and Information Technology, Hatinh University, Hatinh, Viet Nam
Thach S Tran
Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent Clinical School, UNSW Sydney, Sydney, Australia
Dana Bliuc
Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent Clinical School, UNSW Sydney, Sydney, Australia
Hanh M Pham
Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; Fertility Department, Andrology and Fertility Hospital of Hanoi, Hanoi, Viet Nam
Steven A Frost
Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia
Jacqueline R Center
Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent Clinical School, UNSW Sydney, Sydney, Australia
John A Eisman
Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent Clinical School, UNSW Sydney, Sydney, Australia; School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
Tuan V Nguyen
Healthy Ageing Theme, Garvan Institute of Medical Research, Darlinghurst, Australia; St Vincent Clinical School, UNSW Sydney, Sydney, Australia; School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia; School of Biomedical Engineering, University of Technology, Sydney, Australia
This study sought to redefine the concept of fracture risk that includes refracture and mortality, and to transform the risk into "skeletal age". We analysed data obtained from 3521 women and men aged 60 years and older, whose fracture incidence, mortality, and bone mineral density (BMD) have been monitored since 1989. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%) than in men (22%), but mortality risk was higher in men (41%) than in women (25%). The increased risk of mortality was not only present with an initial fracture, but was accelerated with refractures. Key predictors of post-fracture mortality were male gender (hazard ratio [HR] 2.4; 95% CI, 1.79–3.21), advancing age (HR 1.67; 1.53–1.83), and lower femoral neck BMD (HR 1.16; 1.01–1.33). A 70-year-old man with a fracture is predicted to have a skeletal age of 75. These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions.
