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“Introduction A history of non-vertebral fracture (NVF) is associated with a doubling of the risk of a subsequent fracture, and the subsequent fracture risk is quadrupled after a vertebral fracture [1, 2]. This subsequent fracture risk is not constant over time and is driven by the high, three to fivefold increase in the years immediately after a first fracture, followed by a gradual waning off later on [3]. This has been shown for

this website repeat morphometric vertebral fractures [4], subsequent clinical spine, forearm and hip fractures in patients who were hospitalised with a vertebral fracture [5], repeat low-trauma fractures in subjects older than 60 years [6], repeat clinical vertebral and non-vertebral fractures from menopause onwards [3, 7, 8] and repeat hip fractures [9]. As a result, it has been shown in long-term follow-up studies that 40% Venetoclax to 50% of 4-Hydroxytamoxifen molecular weight all subsequent fractures occur within 3 to 5 years after a first fracture. The clinical implication is that patients older than 50 years presenting with a fracture need immediate attention to reduce reversible risk factors of a subsequent fracture. This indicates that to undertake immediate care in fracture patients is necessary, such as the Fracture Liaison Service, the involvement of a fracture nurse and other initiatives in the field of post-fracture

care [10–13]. It also indicates that treatment, which has been shown to reduce fracture risk within short term, should be started as soon as possible in patients with a high fracture risk [14]. An increased risk of mortality has been documented after hip, vertebral and several non-hip, non-vertebral fractures [15]. Similar to subsequent fracture risk, this increase in mortality is higher immediately after fracture than later on. In women and men older than 60 years, nearly 90% of excess deaths related to fracture over the 18 years of observation occurred in the first 5 years. Of the 5-year post-fracture excess mortality, approximately one third of deaths were associated to hip, vertebral and non-hip, non-vertebral fractures, respectively. The major causes of death were related to cardiovascular and respiratory comorbidity and infections [15].