Leslie WD, Yan L, Lix LM, et al. - Over a 10-year period, the risk of major osteoporotic fracture (MOF) and hip re-fracture was increased in all age and gender subgroups. There was inconsistency and only a modest time dependency in early MOF risk, which was particularly noticeable in women over the age of 65. There was no discernible difference in risk between the first 2 years after a fracture and subsequent years.

• Utilizing Province of Manitoba (Canada) healthcare databases, the authors conducted a matched cohort study in 22,105 women (mean age 74.1 ± 10.6 years) and 7,589 men (mean age 71.8 ± 11.2 years) after a first MOF (age ≥ 50 years) during 1989–2006 and matched fracture-free controls (3 for each case).

• Utilizing linear regression, fracture rate ratios (RRs, cases vs controls) stratified by gender and age were computed and tested for linear trend.

• In all subgroups and follow-up intervals, the RRs for incident MOF and hip fracture surpassed unity in the primary analyses.

• RRs had a tendency to decrease over time, but this was inconclusive.

• In all subgroups and observation times, absolute rates per 100,000 person-years for fracture cases were consistently higher than controls.

• Except for younger women, there was a tendency for fracture rates to drop progressively in all subgroups, although these temporal patterns appeared monotonic, with no inflection at 2 years.

• Joinpoint regression studies found no difference in risk between the first two years and subsequent years.

• There was no significant time dependency for incident hip fracture.