{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T13:00:03Z","timestamp":1794488403994,"version":"4.9.1"},"reference-count":50,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"The Canadian Multicentre Osteoporosis Study"},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Amgen Canada Inc"},{"name":"Actavis Pharma Inc"},{"DOI":"10.13039\/100010710","name":"Dairy Farmers of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010710","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019518","name":"Eli Lilly Canada Inc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019518","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004312","name":"Eli Lilly and Company","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004312","id-type":"DOI","asserted-by":"publisher"}]},{"name":"GE Lunar"},{"name":"Hologic Inc"},{"name":"Merck Frosst Canada Ltd"},{"DOI":"10.13039\/100009009","name":"Novartis Pharmaceuticals Canada Inc","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009009","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Pfizer Canada Inc"},{"name":"Sanofi-Aventis Canada Inc"},{"DOI":"10.13039\/501100023798","name":"Servier Canada Inc","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100023798","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000142","name":"The Arthritis Society","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000142","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fracture Risk Assessment Tool (FRAX) defines hip, vertebrae, humerus, and forearm fractures as major osteoporotic fractures (MOF), leading to the misconception that fractures at other sites (NonMOF) are unimportant. We aimed to compare MOF and NonMOF to: (1) assess their contribution to subsequent fracture and mortality risks; (2) evaluate the differences in subsequent fracture and mortality risks between MOF and NonMOF; and (3) assess these contributions using an anatomical classification of hip, vertebral, proximal, and distal fractures. Data from 7568 women and 3366 men aged \u226560 years were utilized from two longitudinal cohorts (the Canadian Multicentre Osteoporosis Study and Dubbo Osteoporosis Epidemiology Study). Initial fractures were classified as MOF or NonMOF (aims 1-2), and as hip, vertebral, proximal, or distal (aim 3). There were 1998 initial fractures in women (38% NonMOF) and 484 in men (48% NonMOF). Over 9551 person-years (py), women experienced 605 subsequent fractures (38% post-NonMOF), while men had 97 subsequent fractures over 2230 py (48% post-NonMOF). Following the initial fracture, 556 women died (29% post-NonMOF) over 12\u2009065 py and 196 men died (38% post-NonMOF) over 2773 py. NonMOF were associated with a 69% increased subsequent fracture risk in women (HR: 1.69, 95% CI 1.47-1.95) and a 2-fold increase in men (2.06; 1.52-2.80), compared to initial fracture, which is comparable to MOF (women: 1.76, 1.56-1.98; men: 2.09, 1.53-2.85). NonMOF imparted &amp;gt;30% excess mortality (women: 1.37, 1.16-1.60; men: 1.33; 1.03-1.72), compared to the fracture-free population, lower than MOF (women: 1.75, 1.54-1.99; men: 2.26, 1.81-2.81) but still substantial. All anatomical fracture sites were associated with subsequent fracture risk, and the risk of mortality increased incrementally from distal to proximal, vertebral, and hip. MOF and NonMOF showed comparable risks of subsequent fracture and mortality. Fractures at all sites are associated with adverse outcomes and should be addressed in clinical care guidelines.<\/jats:p>","DOI":"10.1093\/jbmr\/zjag052","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T15:53:59Z","timestamp":1773330839000},"source":"Crossref","is-referenced-by-count":3,"title":["Fractures at virtually all sites are associated with adverse outcomes: an observational study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0012-9627","authenticated-orcid":false,"given":"Dima A","family":"Alajlouni","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, University of New South Wales Sydney , Sydney 2052 ,","place":["Australia"]},{"name":"Center Lab, Garvan Institute of Medical Research , Sydney 2010 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Medicine\/Endocrinology, Centre for Menstrual Cycle and Ovulation Research, University of British Columbia , Vancouver BC V5Z 1M9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5219-9993","authenticated-orcid":false,"given":"Christopher S","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Memorial University of Newfoundland , St. John\u2019s NL A1B 3V6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudie","family":"Berger","sequence":"additional","affiliation":[{"name":"Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre , Quebec QC H3H 2R9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9116-3742","authenticated-orcid":false,"given":"David A","family":"Hanley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Calgary , Calgary T2N 4N1 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3421-7147","authenticated-orcid":false,"given":"David","family":"Goltzman","sequence":"additional","affiliation":[{"name":"Calcium Research Laboratory, Metabolic Disorders and Complications Program, Research Institute of the McGill University Health Centre , Quebec QC H4A 3J1 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University , Hamilton ON L8N 3Z5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2245-1657","authenticated-orcid":false,"given":"Lisa","family":"Langsetmo","sequence":"additional","affiliation":[{"name":"Center for Care Delivery and Outcomes Research, VA Health Care System , Minneapolis, MN 55417 ,","place":["United States"]},{"name":"Department of Medicine, University of Minnesota , Minneapolis, MN 55455 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4317-492X","authenticated-orcid":false,"given":"Suzanne N","family":"Morin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine and Health Sciences, McGill University , Quebec QC H3G 1Y6 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Josse","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Medicine, University of Toronto , Toronto M5S 3H2 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie M","family":"Kaiser","sequence":"additional","affiliation":[{"name":"Department of Medicine, Dalhousie University , Halifax NS B3H 2Y9 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