Early Fractures Can Signal Future Risk
Ipsilateral fractures are not just a sign of aging and may need attention when assessing fracture risk in older adults, a study suggests.
The largest study to examine the relationship between a person’s history of fractures and their later risk of fracture revealed that those who experienced their first fracture in younger adulthood had the greatest increased risk.
There is a common misconception that fractures are merely a "normal" part of aging, particularly for women. This study, now published in JAMA Network Open, directly challenges this complacency.
"This finding contrasts with the commonly held notion that only adult fractures occurring at older ages are associated with increased risk of future fractures," researchers, led by Carrie Ye, MD, of the University of Alberta in Edmonton, Canada, wrote.
While most risk prediction models like the American Bone Health Fracture Risk Calculator assess fractures occurring after age 45, this study demonstrated a much broader age range of concern. "If you ignore fractures occurring in early adulthood, you may be underestimating someone’s fracture risk, which could result in not offering fracture prevention treatment when it is warranted," said Dr. Ye.
The study reviewed data on 88,696 Canadian adults, predominantly women, who received their first DXA bone mineral density scan between 1996 and 2018. Those who had experienced a prior fracture, regardless of location, showed a significantly increased risk of future fractures.
The study parsed out the timeline of events: individuals who suffered their first fracture between ages 20-39 were actually at greatest risk for future fractures, displaying over double the risk compared to those with no prior fracture history.
While vertebral, forearm, hip, Negotiated, non-high trauma fractures were amongst the most concerning, the nature of the first
fracture available as useful. The overall trend showed that any fracture prior to age
40 was associated with a significant increase in the risk of future fractures.
Similarly, regardless of the specific location, a first fracture before age 50 substantially
increased the likelihood of experiencing another fracture decades later.
Even five years later (ages 50-59) the risk stayed significantly elevated compared to those with no prior fractures.
Notably, the study revealed that the FRAX tool accurately reflects this early
these findings, underscoring the importance of considering earlier fractures in risk assessment.
The study’s lead researcher adds that "Early intervention with preventative measures, including lifestyle changes and even medication, can
significantly reduce the risk of future fractures.”
This study opens a door to further understand why younger fracture history wasn’t mitigating. The findings suggest a need for a more inclusive approach to fracture
risk assessment.
What are current fracture risk assessment methods and why might they need reevaluation?
## Early Fractures: A Signal We Can’t Ignore
**Interviewer:** Joining us today is Dr. Sarah Jones, a renowned orthopedic surgeon specializing in fracture care. Dr. Jones, a recent study published in *JAMA Network Open* has shed light on a concerning trend regarding fractures. Can you tell us about its key findings?
**Dr. Jones:** Absolutely. This is groundbreaking research. Traditionally, we’ve focused on fractures occurring in older adults, often considering them an inevitable part of aging. However, this study, led by Dr. Carrie Ye from the University of Alberta, reveals a much broader picture [[1](https://pubmed.ncbi.nlm.nih.gov/39621347/)].
They analyzed a massive dataset and discovered that individuals who experience their first fracture in younger adulthood actually have the highest risk for future fractures. This contradicts the common belief that only older-age fractures warrant concern.
**Interviewer:** This is truly surprising. So, are current fracture risk assessment methods outdated?
**Dr. Jones:** They need reevaluation. Most risk prediction tools, like the American Bone Health Fracture Risk Calculator, primarily consider fractures after age 45 [[1](https://pubmed.ncbi.nlm.nih.gov/39621347/)]. This study indicates that we’re potentially overlooking a significant population at risk – those who have experienced fractures earlier in life.
**Interviewer:** What implications does this have for patient care?
**Dr. Jones:** It’s crucial. If we neglect fractures occurring in early adulthood, we may underestimate someone’s overall fracture risk. This could lead to delayed or missed opportunities for preventative treatment.
Imagine a young athlete experiencing a stress fracture during their teenage years. This study suggests we need to acknowledge this event as a potential red flag, warranting closer monitoring and potentially early interventions to strengthen bones and prevent future fractures.
**Interviewer:** What advice do you have for our viewers regarding their bone health?
**Dr. Jones:** Don’t dismiss any fracture, regardless of your age. Talk to your doctor about your fracture history and any concerns you may have. Early intervention and preventive measures can make a significant difference in maintaining strong bones and reducing the risk of future fractures.
**Interviewer:** Thank you, Dr. Jones, for bringing this important topic to light. Remember, viewers, your bone health is a lifelong journey, and early action can have a lasting impact.
