OBJECTIVES: The objective was to examine the risk factors associated with recurrent fracture in patients with osteoporotic fracture (OF).

METHODS: A nested case-control study was conducted using the Health Insurance Review & Assessment data between July 2013 and December 2017. Study population included individuals aged ≥50 years with diagnosis for OF in 2015 without previous diagnosis for 1.5 years prior to the index date. we excluded patients with cancer or other bone diseases during the entire period. The cases and controls were defined as patients with and without recurrent fractures within a two-year period following the initial fracture event, respectively. A 1:1 ratio matching of cases and controls was conducted based on cohort entry month. A logistic regression model was employed to evaluate the association between recurrent fracture and potential risk factors.

RESULTS: A total of 116,884 cases and 116,884 controls were selected from a cohort of patients with OF. Patients aged ≥80 years exhibited an elevated risk for recurrent fractures compared to patients aged 50–54 years. Women (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.81–0.85) and Medical Aid beneficiaries (0.91; 0.89–0.94) exhibited a decreased risk for recurrence. Patients who visited tertiary hospitals (0.40; 0.39–0.42), general hospitals (0.58; 0.57–0.59), or hospitals (0.79; 0.77–0.81) for the initial OF exhibited a decreased risk for recurrence compared to patients who visited clinics. Fractures of pelvis (1.35; 1.24–1.46), radius (1.74; 1.70–1.79), and tibia (1.34; 1.29–1.39) exhibited an elevated risk of recurrence, whereas femur fractures (0.83; 0.81–0.85) were associated with a reduced risk of recurrence compared to vertebral fractures. A higher medication possession ratio of osteoporosis medication was associated with a decreased risk for recurrence. Among comorbidities, dementia showed a significant association with recurrence (1.17; 1.13–1.20).

CONCLUSIONS: Factors including sociodemographic, hospital type, fracture type, dementia, and osteoporosis medication were associated with recurrent fractures in patients with OF.