Khalid S, Reyes C, Ernst M, et al. - Risk of imminent fracture is high in older individuals with newly diagnosed osteoporosis and individuals who had a fracture while on treatment with a bisphosphonate.

• This is a multi-cohort study in (database/study period) UK (CPRD/1995–2017), Spain (SIDIAP/2006–2016) and Denmark (DHR/1995–2016).

• Following four cohorts were assessed for 1-year and 2-year fracture risk: (1) newly diagnosed osteoporosis, (2) incident osteoporotic fracture, (3) incident use of oral bisphosphonates and (4) fractures while on treatment with oral bisphosphonates.

• Patients who fracture while on treatment are especially at greater risk of further major osteoporotic fractures at the end of the 1st and 2nd years; this is true for two of the three databases (SIDIAP and CPRD).

• For DHR, individuals with newly diagnosed osteoporosis are at higher risk of major osteoporotic fractures.

• In line with the global epidemiology of osteoporosis, an increased risk of fracture was consistently noted with increasing age.

• Especially, the younger individuals (50–60 years old) included in the fracture while on treatment cohort were at highly elevated risk of fracture, the risk was twice that identified in the same age category in the incident osteoporotic fracture cohort.