Correspondence in response to OSIN-D-18-00831 quantifying imminent risk

We thank Drs. Geusens and van den Bergh for their interest in our paper. We agree that quantifying imminent risk is an important next step. However, there are several factors that need to be considered that impact on such a development, including the following:
The recency of a sentinel fracture. As we report [1], the magnitude of “imminent” risk reduces with time, and thus the timing of the index fracture prior to assessment, be it one day, one week or one year, is critical.

The age at fracture. A prior fracture history is a significant risk factor for fracture at all ages, but the relative risk is highest at younger ages and decreases progressively with age [2].

Age dependency of imminent risk. A recent population-based study showed that the phenomenon of immediate risk was also age-dependent, the transient effect being more evident at older ages [3].

The site of sentinel fracture [1].

Sex. The difference in risk is greater for men than for women for all ages [1]

The non-linear mortality following a hip or vertebral fracture [4, 5].

All these factors need to be taken into account to quantify risks for individuals. Thus, the request of Geusens and van den Bergh cannot be instantly accommodated.