Short time horizons for fracture prediction tools : Time for a rethink

[Extract] Prior fragility fracture is a well-established risk factor for a future fracture [1,2,3,4]. The population relative risk of having a subsequent hip fracture or other osteoporotic fracture is approximately 2-fold higher for most types of prior fracture. However, many studies suggest that the increase in risk is not constant with time or age. Indeed, the risk of a subsequent osteoporotic fracture is particularly acute immediately after an index fracture and wanes progressively over the next 2 years [4,5,6,7,8,9] but thereafter remains higher than that of the general population (Fig. 1). The early phase of particularly high risk has been termed imminent risk [9]. This transiency, which is not currently accommodated in any of the available fracture risk assessment tools, suggests that treatment given to patients immediately after a fracture might avoid a higher number of new fractures compared with treatment given at a later date.