Epidemiology and burden of imminent subsequent fractures in postmenopausal women

1. Key research question

How common are repeat fractures for postmenopausal women, what makes some women more vulnerable, and what is the economic burden on healthcare systems?

2. Summary of findings

Our analysis of data from France, Germany, Italy, the Netherlands, Spain and the UK shows that many women who experience a first osteoporotic fracture go on to have another one within two years with the incidence between countries. Women who sustain a subsequent fracture are typically older, have more health problems, take more medications, and have more healthcare visits than those who do not fracture again. Osteoporotic fractures place a heavy burden on healthcare systems with a first fracture leading to a significant increase in the use and costs of healthcare services , and a second one within two years adding a similar level of pressure.

3. What problem did we address?

Osteoporosis makes bones fragile, particularly in postmenopausal women. A first fracture signals a much greater chance of another fracture occurring soon after, often within just 12–24 months.

Yet little is known about who is most at risk of these “imminent subsequent fractures” with many women remaining vulnerable to further harm that could be prevented.

Fractures require substantial medical care across different healthcare settings, from primary care to hospitals. But the extent to which repeat fractures lead to additional healthcare resources and costs is not well understood.

This study addresses this gap by providing clear and consistent multi-country evidence to guide better prevention and policy.

4. What was our main objective?

• To describe the characteristics of postmenopausal women who experience another fracture within two years of their first one.
• To measure how often these imminent subsequent fractures occur.
• To estimate the impact of osteoporotic fractures on healthcare use and costs.

5. Why is this project important?

A second fracture is more than “just a fracture”; it often marks a turning point in health, independence, and mortality. It also amplifies hospitalisations, clinic visits and costs. If health systems can spot high-risk women early, they can intervene before another fracture occurs. This study creates the evidence needed to support smarter, more proactive fracture-prevention strategies across Europe.

6. What data did we use?

We analysed anonymised health records from six European nations: the UK, France, Germany, Italy, Netherlands and Spain. The data were drawn from primary care systems, with linked hospital records included for the UK and Spain. All datasets were mapped to the Observational and Medical Outcomes Partnership (OMOP) common data model (CDM), a standardised format that harmonises datasets into a common structure and terminology using pre-specified vocabularies. This allowed the same analytical code to be run across all countries without sharing any patient-level data.
The datasets included information on diagnoses, prescriptions, hospital stays and healthcare visits, enabling a comprehensive view of patients’ journeys reflecting everyday (i.e., real-world) clinical practice. The large sample sizes also enabled the study to detect even modest differences between countries and patient groups.

7. Which methods did we use?

We conducted a retrospective cohort study comparing women with no fractures, women with a first fracture, and women who went on to have a subsequent fracture within two years of their initial fracture. To ensure fair and balanced comparisons between these groups, we used advanced statistical matching methods, including seasonal and propensity-score matching. We then measured healthcare use across primary care (such as GP visits), hospital admissions, and applied country-specific unit costs to estimate the associated healthcare expenditure attributed to those fractures.

8. What did we find?

Our key findings include:

• The incidence of imminent subsequent fractures varied considerably across the countries we studied: rates ranged from 118 to 321 per 1,000 person-years, observed to be highest in Italy and lowest in the UK.
• Subsequent fractures most often occur in the same site as the first.
• Women who suffer subsequent fractures are older and in poorer health, with more cardiovascular disease, diabetes, mental-health conditions, and medication use.

A first fracture leads to substantial increase in healthcare use and costs, with an imminent subsequent one adding just as much. 

9. Looking ahead

The findings from this study point to a clear path forward: prevention at the moment a first fracture occurs will significantly reduce fractures and their consequences on patients and their families and reduce the cost burden on healthcare services. Healthcare systems across Europe have a unique opportunity to reduce avoidable harm by strengthening secondary fracture prevention services, improving early assessment and ensuring that women receive timely osteoporosis diagnosis and treatment. 

As the study shows, the first 12–24 months after a fracture are a critical window in which effective intervention can dramatically cut the risk of a subsequent fracture.

This work also highlights the need for awareness among both patients and clinicians. A fracture is not an isolated event but a warning signal. Responding to it swiftly and proactively can protect independence, reduce pain, and prevent avoidable hospitalisations. By transforming how we recognise and manage fracture risk, we can meaningfully improve the lives of millions of women and their families across Europe.

Finally, this study marks the first use of OMOP-mapped data to analyse healthcare use and costs across multiple countries, demonstrating the feasibility of this approach and paving the way for broader international applications in the future.

Funded by

UCB Biopharma SRL

Research outputs

• Poster – ISPE conference 2024 (Method)
• Poster – ISPE conference 2024 (Primary care analysis)
• Poster – ISPOR Europe 2024 (Secondary care analysis)
• Presentation – ISPOR Europe 2024 (Primary care analysis)