Reduced Risk of Recurrent Fragility Fractures After a Primary Care–Based Fracture Prevention Intervention: A 20-Year Non-Randomized Controlled Follow-Up Study in Women Aged 70–100

In Sweden 70,000 people suffer fragility fractures annually, including 16,000 hip fractures with one-year mortality of up to 25%. Strategies to prevent falls, improve physical function, and enhance bone strength have shown mixed results. To evaluate the incidence of hip and other fragility fractures following a fracture prevention intervention and assess baseline risk factors for long-term fracture outcomes. 1,233 rural Swedish women aged 70–100 years in 2002 were followed until 2021 after a primary care-based, non-randomized graded fracture prevention intervention 2002–2004 that included physical activity, fall prevention, and pharmacological treatment tailored to hip fracture risk. Fractures were identified through radiology reports 2002–2021. The most common fractures occurred in the hip with 236 women sustaining 268 hip fractures with highest incidence in women aged 90–94 years. One-year hip fracture mortality was 27%. Hip fractures occurred in 17.7% of the intervention group (77/434) and 19.9% of controls (159/799, <i>p</i> = 0.36). Repeated fragility fractures occurred in 14.1% of the intervention group and 18.6% of controls (OR 0.71; 95% CI 0.53–1.0, <i>p</i> = 0.047), particularly when one fracture involved the hip (OR 0.54 (95% CI 0.31–0.95), <i>p</i> = 0.037). Increasing age (HR 1.8–4.0), height &gt;167 cm (HR 1.6; 95% CI 1.1–2.2), and weight &lt;60 kg (HR 1.5; 95% CI 1.1–2.0) were significant baseline risk factors. We noticed a non-significant reduction in hip fractures after 20 years, yet repeated fractures were less frequent in the intervention group suggesting a potential long-term benefit. Older, taller and lighter women were at greater risk for hip fracture.