. 2020 Sep 13;6(3):151–159. doi: 10.1016/j.afos.2020.08.003

Table 2.

List of studies investigating the relationship between ankle fracture and subsequent fracture.

Study [Reference]	Study design	Study population	Total sample	Average time of follow-up, yr)	Initial ankle fracture case	Initial non-fracture case	Associated/Subsequent fracture type	Subsequent fracture case	Type of risk	Value (95% CI)
Biver E [9]	Cross-sectional	Geneva Retirees Cohort, Switzerland (female, mean 65 yr)	749	N/A	63	433	Any	N/A	OR	2.08 (1.24–3.5) P = 0.006^a
Biver E [9]	Cross-sectional	Geneva Retirees Cohort, Switzerland (female, mean 65 yr)	749	N/A	63	433	Fragility fracture	N/A	OR	1.89 (1.04–3.44) P = 0.037^a
Center JR [11]	Prospective cohort	Dubbo Osteoporosis Epidemiology Study, Australia (female and male aged ≥ 60 yr)	Total 4005
			Female 2245	16	905 initial fracture, no specified data for ankle fracture	1340	Any	253 after all initial fracture, 7 after ankle fracture	RR	0.84 (0.4–1.78)
			Male 1760	15	337 initial fracture, no specified data for ankle fracture	1423	Any	71 after all initial fracture, 10 after ankle fracture	RR	4.59 (2.45–8.61)^a
Ettinger B [5]	Prospective cohort	Northern California, USA, retrieved from the Kaiser Permanente Medical care program (male ≥ 60 yr)	90825	2.4	1067	Normal population 86408	Ankle, hip, humerus, wrist	N/A	HR after adjust for all - age, cardiac related drug use, central nervous system related drug use, DM drug use, hospitalization, office visit	1 (0.5–1.9)
Ettinger B [5]	Prospective cohort		90825	2.4	1067	Finger fracture 841	Ankle, hip, humerus, wrist	N/A		1 (0.4–2.6)
GehlbachS [18].	Prospective cohort	Global Longitudinal Study of Osteoporosis in Women (GLOW), 10 countries (female, mean age 68 yr)	51762	2	3201	39753	Any	N/A	HR adjusted for age, physician practice site, multiple previous fractures	1.4 (1.24–1.58)^a
							Hip	N/A		1.45 (0.95–2.2)
							Spine	N/A		1.24 (0.86–1.8)
							Other weight bearing bone	N/A		1.83 (1.52–2.19)^a
							Non-weight bearing bone	N/A		1.15 (0.95–1.39)
Greenfield DM [20]	Cross-sectional	Postmenopausal women recruited at Northern General Hospital Trust, Sheffield, England (female, mean age 64.2)	478	N/A	103	375	Distal forearm	26%	OR	2.82^a
							Hip	2%		1.84
							Spine	10%		1.43
Ingle BM [19]	Cross sectional	Postmenopausal women recruited at Northern General Hospital Trust, Sheffield, England (female, mean age 62.2)	62	N/A	31	31	Distal forearm	24%	OR	3.63^a
Ingle BM [19]	Cross sectional						Hip	2%	OR	2.02
Lauritzen JB [23]	Prospective cohort	Inpatient at Hvidovre Hospital, Copenhagen, Denmark (admitted fracture lumbar spine, knee, ankle) (female aged 60–99)	451	Median 3.6 (from initial ankle fracture)	Total 200		Hip	8	RR	1.3 (0.6–2.7)
					Aged 60–79, 182		Hip	7		1.5 (0.6–3.1)
					Aged 80–99, 18		Hip	1		0.7 (0.02–4.0)
Morin SN [17]	Retrospective cohort	Women undergoing baseline clinical BMD from 1990 to 2007 from the database of Manitoba, Canada (female, mean age 64.3)	39991	5.3	1694	29878	Major osteoporotic fracture	N/A	HR adjusted for decades of age, femoral neck BMD	1.3 (1.08–1.57)
Pritchard JM [22]	Prospective cohort	Females with or without DM from Population Health Information System (POPULIS) data repository at the Manitoba Centre for Health Policy (MCHP), Canada from 1987 to 2007 (female, mean age 67.9)	12205	4.8	559	11646	Major osteoporotic fracture	66	HR adjusted for age, BMI, femoral neck BMD, previous major osteoporotic fracture, number of ADGs 1.17	(0.79–1.73), P = 0.316
Robinson CM [8]	Prospective cohort	Inpatients and outpatients with fracture at Edinburgh Orthopaedic Trauma Unit, Scotland, United Kingdom (female and male aged ≥ 45)	22060	3.6	3508	Baseline population	Hip	N/A	RR	1.3 (0.95–1.82)
							Wrist	N/A		2.03 (1.62–2.51)^a
							Proximal humerus	N/A		1.96 (1.32–2.81)^a
							Ankle	N/A		4.53 (3.57–5.66)^a
							Any	N/A		2.24 (1.89–2.59)^a
Taylor AJ [21]	Retrospective cohort	5% random sample of Medicare beneficiaries from 2000 to 2005, obtained from Center of Medicare and Medicaid Services (CMS) Chronic Condition Warehouse (male and female aged ≥ 65)	1694051	4.2 person-year	13454	1525735	Hip	N/A	IRR adjusted for gender, race, age, year, urbanicity, geographic region, income	0.99 (0.91–1.08)
							Spine	N/A		1.14 (1.04–1.25)^a
							DER + Ulna	N/A		1.27 (1.12–1.43)^a
							Humerus	N/A		0.96 (0.82–1.11)
							Ankle	N/A		N/A
							Tibia + Fibula	N/A		2.6 (2.19–3.09)

OR, odds ratio; RR, relative risk; HR, hazard ratio; CI, confidence interval; BMD, bone mineral density; BMI, body mass index; ADG, ambulatory diagnostic group; IRR, incidence rate ratio; DM, diabetes mellitus; N/A, not applicable.

Statistically significant; all ages are in years.