Incidence and risk factors of subsequent osteoporotic fracture: a nationwide cohort study in South Korea
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Incidence and risk factors of subsequent osteoporotic fracture: a nationwide cohort study in South Korea Yoon-Bo Shim 1 & Jae-A Park 1 & Jin Hyun Nam 1 & Sung-Hyun Hong 1 & Ji Wan Kim 2 & Jihae Jeong 3 & Ju-Young Shin 1,4 Received: 30 July 2020 / Accepted: 5 November 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary This study analyzed the incidence and risk factors of subsequent osteoporotic fractures in South Korea. The results showed that the incidence rate of subsequent fractures within 24 months was 10.23 per 100 person-years. Additionally, the index hip fracture site was a significant risk factor for a subsequent fracture. Purpose To identify and analyze the incidence and risk factors of subsequent osteoporotic fractures in South Korea. Methods This retrospective cohort study analyzed data from the National Health Insurance Review and Assessment claims database from 2012 to 2017. Men and women with osteoporosis, aged ≥50 years, with index fractures between July 1, 2014, and July 1, 2015, were included. The incidence rate of subsequent fractures was calculated by determining the number of second event within 2 years from the index fracture. To identify the risk factors for subsequent fractures, we applied the Cox proportional hazard model to estimate the hazard ratios (HRs). Results Of the 73,717 patients with osteoporotic fractures, 13,203 (17.91%) had a subsequent fracture. The incidence rate of subsequent fractures within 24 months was 10.23/100 person-years. The index fracture site was a significant risk factor for a subsequent fracture, with the hip showing the highest risk (HR, 7.51; 95% confidence interval [CI], 6.77–8.34), followed by the vertebra (HR, 1.99; 95% CI, 1.91–2.06). The risk of subsequent fractures increased with a higher Charlson Comorbidity Index (CCI) score (CCI score ≥ 5: HR, 1.79; 95% CI, 1.67–1.92). Conclusion The incidence rate of subsequent osteoporotic fractures in South Korea is similar or higher than that reported in the USA and Europe. A hip fracture within the prior 2 years, relative to other fracture sites, significantly increased the risk of subsequent fractures in osteoporosis patients. Patients who have these risk factors need closer disease management to prevent subsequent fractures. Keywords Epidemiology . Osteoporotic fracture . Subsequent fracture . Fracture risk factors . Incidence
Introduction With the globally aging population, approximately 200 million people worldwide have been diagnosed with osteoporosis, a chronic metabolic bone disease that worsens bone * Ju-Young Shin [email protected] 1
School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, Republic of Korea
2
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
3
Amgen Korea, Seoul, Republic of Korea
4
Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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