All fractures in the hospital are coded (ICD-9) and stored in the hospital database. Second, vertebral fractures were excluded because of difficulty with verification of timing of these fractures. Third, we have no data on the trauma

mechanism. In earlier studies, we have shown that about 20% of clinical fractures are not resulting from a fall www.selleckchem.com/PARP.html from maximum standing height or lesser trauma [28]. However, Mackay et al. [29] have shown that the risk of subsequent fractures is similar after high- and low-energy trauma. There are no data available for mortality after high- and low-energy trauma in fractures. Fourth, there are no data on the cause of death. We therefore cannot correlate if these deaths are directly related to the previous fracture or the subsequent fracture. The enhanced mortality could be a sign of poor health or other underlying conditions. Further studies will be necessary to examine to what degree bone and extraskeletal risks are predictive of subsequent fractures and mortality. Others have shown

that bone, fall and general health-related factors could be involved [15]. In conclusion, we found that within 5 years after an initial NVF, nearly one in five patients sustained a subsequent NVF and one in three died. selleck products One third of subsequent NVFs and mortality occurred within 1 year, indicating the need to study which reversible factors can be targeted to immediately prevent subsequent fractures and mortality. Conflict of interest None. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. References 1. Kanis JA, Johnell O, De Laet C, Johansson H, Oden

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