{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:45:15Z","timestamp":1792889115633,"version":"4.5.0"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi241354-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Fragility fractures are often defined as those that occur after a certain age (eg, 40-50 years). Whether fractures occurring in early adulthood are equally associated with future fractures is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241354-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine whether the age at which a prior fracture occurred is associated with future fracture risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241354-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This observational, population-based cohort study included individuals from the Manitoba Bone Mineral Density Registry with a first bone mineral density (BMD) measurement between January 1, 1996, and March 31, 2018, with and without prior fracture in adulthood. Data analysis was completed between April 1, and May 31, 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241354-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Individuals with fractures before their first dual-energy x-ray absorptiometry were stratified by the age at first fracture (10-year intervals from 20-29 to \u226580 years of age).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241354-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Incident fractures occurring after dual-energy x-ray absorptiometry (index date) and before March 31, 2021, were identified using linked provincial administrative health data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241354-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 88\u202f696 individuals (80\u202f066 [90.3%] female; mean [SD] age, 64.6 [11.0] years) with a mean (SD) femoral neck T score of \u22121.4 (1.0). A total of 21\u202f105 individuals (23.8%) had sustained a prior fracture at a mean (SD) age of 57.7 (13.6) years (range, 20.0-102.4 years) at the time of first prior fracture. During a mean (SD) of 9.0 (5.5) years of follow-up, incident fractures occurred in 13\u202f239 individuals (14.6%), including 12\u202f425 osteoporotic fractures (14.0%), 9440 major osteoporotic fractures (MOFs) (10.6%), and 3068 hip fractures (3.5%). The sex- and age-adjusted hazard ratios for all incident fractures, osteoporotic fractures, and MOFs, according to age at first fracture, were all significantly elevated, with point estimates ranging from 1.55 (95% CI, 1.28-1.88) to 4.07 (95% CI, 2.99-5.52). After adjusting for the additional covariates, the effect estimates were similar and remained significantly elevated, with point estimates ranging from fully adjusted hazard ratios of 1.51 (95% CI, 1.42-1.60) to 2.12 (95% CI, 1.67-2.71) across age categories. Sensitivity analyses examining age at last prior fracture and in those with multiple prior fractures showed similar results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi241354-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study, fractures in adulthood were associated with future fractures regardless of the age at which they occurred. Thus, fractures in early adulthood should not be excluded when assessing an individual\u2019s ongoing fracture risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.48208","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T11:01:18Z","timestamp":1733137278000},"page":"e2448208","source":"Crossref","is-referenced-by-count":14,"title":["Age at First Fracture and Later Fracture Risk in Older Adults Undergoing Osteoporosis Assessment"],"prefix":"10.1001","volume":"7","author":[{"given":"Carrie","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne N.","family":"Morin","sequence":"additional","affiliation":[{"name":"Department of Medicine, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Lix","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene V.","family":"McCloskey","sequence":"additional","affiliation":[{"name":"Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom"},{"name":"MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Johansson","sequence":"additional","affiliation":[{"name":"Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom"},{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom"},{"name":"Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas C.","family":"Harvey","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom"},{"name":"NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Kanis","sequence":"additional","affiliation":[{"name":"Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D.","family":"Leslie","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"issue":"3","key":"zoi241354r1","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1007\/s40618-023-02219-9","article-title":"An overview of the use of the fracture risk assessment tool (FRAX) in osteoporosis.","volume":"47","author":"Schini","year":"2024","journal-title":"J Endocrinol Invest"},{"issue":"12","key":"zoi241354r2","doi-asserted-by":"publisher","first-page":"2027","DOI":"10.1007\/s00198-023-06870-z","article-title":"Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX.","volume":"34","author":"Kanis","year":"2023","journal-title":"Osteoporos Int"},{"issue":"2","key":"zoi241354r3","doi-asserted-by":"publisher","first-page":"68","DOI":"10.24095\/hpcdp.41.2.06","article-title":"Release notice\u2014osteoporosis and related fractures in Canada: report from the Canadian Chronic Disease Surveillance System 2020.","volume":"41","year":"2021","journal-title":"Health Promot Chronic Dis Prev Can"},{"issue":"10","key":"zoi241354r4","doi-asserted-by":"publisher","first-page":"2103","DOI":"10.1007\/s00198-022-06435-6","article-title":"Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan.","volume":"33","author":"Vandenput","year":"2022","journal-title":"Osteoporos Int"},{"issue":"4","key":"zoi241354r5","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/j.carj.2013.07.006","article-title":"Canadian Association of Radiologists technical standards for bone mineral densitometry reporting.","volume":"64","author":"Siminoski","year":"2013","journal-title":"Can Assoc Radiol J"},{"issue":"4","key":"zoi241354r8","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1007\/s002239900237","article-title":"Associations of early premenopausal fractures with subsequent fractures vary by sites and mechanisms of fractures.","volume":"60","author":"Honkanen","year":"1997","journal-title":"Calcif Tissue Int"},{"issue":"4","key":"zoi241354r9","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s001980200035","article-title":"Fractures before menopause: a red flag for physicians.","volume":"13","author":"Hosmer","year":"2002","journal-title":"Osteoporos Int"},{"issue":"1","key":"zoi241354r10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1001\/archinte.162.1.33","article-title":"Fractures between the ages of 20 and 50 years increase women\u2019s risk of subsequent fractures.","volume":"162","author":"Wu","year":"2002","journal-title":"Arch Intern Med"},{"issue":"2","key":"zoi241354r11","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1007\/s00198-014-2897-9","article-title":"Prior fracture as a risk factor for future fracture in an Australian cohort.","volume":"26","author":"Holloway","year":"2015","journal-title":"Osteoporos Int"},{"issue":"1","key":"zoi241354r13","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1385\/JCD:8:1:025","article-title":"Construction and validation of a population-based bone densitometry database.","volume":"8","author":"Leslie","year":"2005","journal-title":"J Clin Densitom"},{"issue":"11","key":"zoi241354r15","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1345\/aph.18117","article-title":"Validation of an electronic, population-based prescription database.","volume":"32","author":"Kozyrskyj","year":"1998","journal-title":"Ann Pharmacother"},{"key":"zoi241354r17","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/1471-2458-12-301","article-title":"Osteoporosis-related fracture case definitions for population-based administrative data.","volume":"12","author":"Lix","year":"2012","journal-title":"BMC Public Health"},{"issue":"1","key":"zoi241354r18","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s11657-021-00980-z","article-title":"Assessment of site-specific X-ray procedure codes for fracture ascertainment: a registry-based cohort study.","volume":"16","author":"Leslie","year":"2021","journal-title":"Arch Osteoporos"},{"issue":"6","key":"zoi241354r19","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1016\/j.berh.2009.09.002","article-title":"How to decide who to treat.","volume":"23","author":"Kanis","year":"2009","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"39","key":"zoi241354r20","doi-asserted-by":"publisher","first-page":"E1333","DOI":"10.1503\/cmaj.221647","article-title":"Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update.","volume":"195","author":"Morin","year":"2023","journal-title":"CMAJ"},{"issue":"2","key":"zoi241354r21","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.bone.2004.03.024","article-title":"A meta-analysis of previous fracture and subsequent fracture risk.","volume":"35","author":"Kanis","year":"2004","journal-title":"Bone"},{"issue":"17","key":"zoi241354r23","doi-asserted-by":"publisher","first-page":"1864","DOI":"10.1503\/cmaj.100771","article-title":"2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary.","volume":"182","author":"Papaioannou","year":"2010","journal-title":"CMAJ"},{"key":"zoi241354r6","unstructured":"Fracture risk calculator. Garvan Institute of Medical Research. Accessed May 23, 2024. https:\/\/fractureriskcalculator.com.au\/calculator\/"},{"key":"zoi241354r7","unstructured":"Strickland S. Fracture risk calculator\u2014American Bone Health. Bone Health & Osteoporosis Foundation. January 28, 2020. Accessed May 23, 2024. https:\/\/americanbonehealth.org\/calculator\/"},{"key":"zoi241354r12","unstructured":"Manitoba Bureau of Statistics. Province of Manitoba. Accessed May 21, 2024. https:\/\/www.gov.mb.ca\/mbs\/"},{"key":"zoi241354r14","unstructured":"Manitoba Bone Density Program. Province of Manitoba. Accessed September 24, 2024. https:\/\/www.gov.mb.ca\/health\/primarycare\/providers\/chronicdisease\/bonedensity\/"},{"key":"zoi241354r16","unstructured":"Manitoba Vital Statistics Branch. Province of Manitoba. Accessed March 21, 2023. https:\/\/vitalstats.gov.mb.ca\/"},{"key":"zoi241354r22","unstructured":"FRAX calculation tool. Centre for Metabolic Bone Diseases, University of Sheffield, UK. Accessed May 23, 2024. https:\/\/frax.shef.ac.uk\/FRAX\/tool.aspx?country=19"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2827189\/ye_2024_oi_241354_1732139535.23274.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T11:01:20Z","timestamp":1733137280000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2827189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,2]]},"references-count":23,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.48208","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,2]]}}}