Open Access Research article

The role of the combination of bone and fall related risk factors on short-term subsequent fracture risk and mortality

Kirsten MB Huntjens1*, Tineke ACM van Geel2, Svenhjalmar van Helden3, Joop van den Bergh456, Paul Willems7, Bjorn Winkens8, Piet P Geusens569 and Peter RG Brink1

Author Affiliations

1 Department of Trauma Surgery, Maastricht University Medical Centre, School for Public Health and Primary Care (CAPHRI), P. Debyelaan 25, P.O. Box 5800, Maastricht, 6202 AZ, The Netherlands

2 Department of General Practice, Maastricht University/Caphri, Maastricht, the Netherlands

3 Department of Trauma Surgery, Isala klinieken, Zwolle, The Netherlands

4 Department of Internal Medicine, Viecuri Venlo, the Netherlands

5 Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands

6 Biomedical Research Institute, University Hasselt, Hasselt, Belgium

7 Department of Orthopaedic surgery, Maastricht University Medical Centre, Maastricht, the Netherlands

8 Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands

9 Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands

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BMC Musculoskeletal Disorders 2013, 14:121  doi:10.1186/1471-2474-14-121

Published: 4 April 2013



We analysed whether a combination of bone- and fall-related risk factors (RFs) in addition to a recent non-vertebral fracture (NVF) contributed to subsequent NVF risk and mortality during 2-years in patients who were offered fall and fracture prevention according to Dutch fracture- and fall-prevention guidelines.


834 consecutive patients aged ≥50 years with a recent NVF who were included. We compared subgroups of patients according to the presence of bone RFs and/or fall RFs (group 1: only bone RFs; group 2: combination of bone and fall RFs; group 3: only fall RFs; group 4: no additional RFs). Univariable and multivariable Cox regression analyses were performed adjusted for age, sex and baseline fracture location (major or minor).


57 (6.8%) had a subsequent NVF and 29 (3.5%) died within 2-years. Univariable Cox regression analysis showed that patients with the combination of bone and fall RFs had a 99% higher risk in subsequent fracture risk compared to all others (Hazard Ratio (HR) 1.99; 95% Confidence Interval (CI) 1.18-3.36) Multivariable analyses this was borderline not significant (HR 1.70; 95% CI: 0.99-2.93). No significant differences in mortality were found between the groups.


Evaluation of fall RFs contributes to identifying patients with bone RFs at highest immediate risk of subsequent NVF in spite of guideline-based treatment. It should be further studied whether earlier and immediate prevention following a NVF can decrease fracture risk in patients with a combination of bone and fall RFs.