Family History of Fracture Significantly Raises Future Fracture Risk: Meta-Analysis Finds
UK: A large-scale meta-analysis published in Osteoporosis International reinforces the role of family fracture history as a critical predictor of future fracture risk, independent of bone mineral density (BMD). The study, led by Eugene V. McCloskey and colleagues from the Centre for Metabolic Bone Diseases, University of Sheffield, highlights the potential need to update fracture risk assessment models, including the widely used FRAX tool, to reflect these findings.
The analysis combined data from 42 international cohorts across 29 countries, encompassing 350,542 men and women and covering a total of 2.8 million person-years of follow-up. Researchers examined whether a family history of hip fracture or any fracture influences the likelihood of future fractures, including major osteoporotic fractures (MOF) and hip fractures specifically.
The study led to the following findings:
- A parental history of hip fracture significantly increased the risk of future fractures across all categories.
- The greatest impact was seen for hip fractures, where risk rose by 37% (HR 1.37).
- Major osteoporotic fracture risk was 19% higher (HR 1.19).
- These associations remained significant even after adjusting for BMD and other factors, confirming independence from bone density.
- The effect of family fracture history was consistent across genders and unaffected by age, follow-up time, or which parent was affected.
- Parental history of any fracture and sibling history also showed similar risk patterns.
These findings underline the importance of incorporating family fracture history into clinical assessments. According to the authors, while parental hip fracture remains the most powerful single predictor, the role of other familial fractures warrants consideration for inclusion in future iterations of the FRAX tool, which is widely used to estimate fracture risk and guide osteoporosis management strategies globally.
The authors noted that the large scale of the meta-analysis and the diversity of included populations strengthen the reliability and generalizability of the results. However, they emphasized that further research may be needed to explore whether incorporating sibling fracture history could enhance fracture prediction models.
"The study confirms that a family history of fractures is a strong predictor of future fracture risk, independent of bone mineral density. While parental hip fracture remains the most influential factor for predicting future hip fractures, incorporating a broader family history of fractures could be valuable in future updates of the FRAX tool," the authors concluded.
Reference:
McCloskey, E.V., Johansson, H., Liu, E. et al. Family history of fracture and fracture risk: a meta-analysis to update the FRAX® risk assessment tool. Osteoporos Int (2025). https://doi.org/10.1007/s00198-025-07607-w
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