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Regardless of age, fracture in adulthood was linked to a higher risk of future fractures in older adults, emphasizing the need for early osteoporosis exams.

Fractures in adulthood, regardless of the age at which they occurred, were associated with future fractures in older adults undergoing osteoporosis assessment, according to a study published in JAMA Network Open.

“This finding contrasts with the commonly held notion that only adult fractures occurring at older ages are associated with increased risk of future fractures,” wrote corresponding author Carrie Ye, MD, and colleagues.

The observational, population-based cohort study included 88,696 adults aged 40 years and older from the Manitoba Bone Mineral Density Registry. Participants had a first bone mineral density measurement between 1996 and 2018. Among them, 21,105 had sustained a prior fracture in adulthood.

To investigate whether age at prior fracture was linked with the risk of future fracture, researchers stratified adults by age at first fracture in 10-year intervals from 20 to 29 years of age to 80 years or older.

Over an average of 9 years of follow-up after dual-energy x-ray absorptiometry, 13,239 adults experienced an incident fracture. Among the fractures, 14.0% were osteoporotic fractures, occurring at any site other than the ankle; 10.6% were major osteoporotic fractures (MOFs), occurring at the hip, vertebrae, forearm, or humerus; and 3.5% were hip fractures.

“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),” researchers reported.

According to the study, effect estimates were similar and remained significantly elevated after adjusting for the additional covariates. Point estimates from fully adjusted hazard ratios ranged from 1.51 to 2.12 across age categories.

Results were similar in a sensitivity analysis that investigated adjusted hazard ratios for incident fracture by age at last prior fracture instead of first fracture and in a subgroup analysis of adults with single versus multiple prior fractures.

“Although there was no statistically significant trend in AHRs [adjusted hazard ratios] for incident fracture with increasing age of first prior fracture, AHRs for incident fracture were slightly higher in the younger age categories, underscoring the importance of including fractures occurring in younger adults to avoid underestimating incident fracture risk,” researchers wrote.