Top

Published in:

01-05-2009 | Locomotor Diseases

Estimation of absolute fracture risk among middle-aged and older men and women: the EPIC-Norfolk population cohort study

Authors: Alireza Moayyeri, Stephen Kaptoge, Robert N. Luben, Nicholas J. Wareham, Sheila Bingham, Jonathan Reeve, Kay Tee Khaw

Published in: European Journal of Epidemiology | Issue 5/2009

Abstract

While estimates of relative risks associated with risk factors such as age and bone mineral density (BMD) may be of interest for etiologic and comparative purposes, clinical questions such as who might benefit most from preventive interventions or BMD monitoring depend on estimates of absolute fracture risk. The European prospective investigation into cancer (EPIC)-Norfolk study included 25,311 participants (11,476 men) aged 4,079 years in 1993–1997. All participants were followed for osteoporotic fractures to March 2007. Ten-year absolute risk of fracture in men and women were calculated using the baseline survivor function in multivariable Cox proportional-hazards models adjusting for age, sex, history of fractures, body mass index, smoking, and alcohol intake. In comparison of those without history of fracture versus those with history of fracture, the 10-year absolute risk of any fracture in men ranged from 1.0 vs. 1.2% at age 40 years to 3.0 vs. 4.4% at age 75 years. The respective estimates in women ranged from 0.7 vs. 1.0% at age 40 years to 9.3 vs. 17.2% at age 75 years. Statistically significant interaction between age and sex was found (P < 0.001), which contributed to the differences in predicted absolute fracture risks for men and women at different ages. Our study shows the need for population-specific data to develop efficient well calibrated algorithms for assessment of fracture risk. The interaction observed between sex and age points to the need for further prospective studies among men.

Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12:989–95. doi:10.1007/s001980170006.PubMedCrossRef

Tucker G, Metcalfe A, Pearce C, Need AG, Dick IM, Prince RL, et al. The importance of calculating absolute rather than relative fracture risk. Bone. 2007;41:937–41. doi:10.1016/j.bone.2007.07.015.PubMedCrossRef

Siminoski K, Leslie WD, Frame H, Hodsman A, Josse RG, Khan A, et al. Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J. 2005;56:178–88.PubMed

Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, et al. Assessment of fracture risk. Osteoporos Int. 2005;16:581–9. doi:10.1007/s00198-004-1780-5.PubMedCrossRef

Leslie WD, Metge C, Ward L. Contribution of clinical risk factors to bone density-based absolute fracture risk assessment in postmenopausal women. Osteoporos Int. 2003;14:334–8. doi:10.1007/s00198-003-1375-6.PubMedCrossRef

Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA. 2002;288:1889–97. doi:10.1001/jama.288.15.1889.PubMedCrossRef

De Laet C, Oden A, Johansson H, Johnell O, Jonsson B, Kanis JA. The impact of the use of multiple risk indicators for fracture on case-finding strategies: a mathematical approach. Osteoporos Int. 2005;16:313–8. doi:10.1007/s00198-004-1689-z.PubMedCrossRef

Ettinger B, Hillier TA, Pressman A, Che M, Hanley DA. Simple computer model for calculating and reporting 5-year osteoporotic fracture risk in postmenopausal women. J Womens Health (Larchmt). 2005;14:159–71. doi:10.1089/jwh.2005.14.159.CrossRef

Melton LJIII, Johnell O, Lau E, Mautalen CA, Seeman E. Osteoporosis and the global competition for health care resources. J Bone Miner Res. 2004;19:1055–8. doi:10.1359/JBMR.040316.PubMedCrossRef

10.

Kanis JA. World Health Organization Scientific Group. Assessment of osteoporosis at the primary health-care level. Technical Report. UK: World Health Organization Collaborating Center for Metabolic Bone Disease, University of Sheffield; 2007.

11.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19:385–97. doi:10.1007/s00198-007-0543-5.PubMedCrossRef

12.

Cooper C, Campion G, Melton LJIII. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285–9. doi:10.1007/BF01623184.PubMedCrossRef

13.

Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jonsson PV, et al. International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for research on aging. Osteoporos Int. 1999;9:242–53. doi:10.1007/s001980050144.PubMedCrossRef

14.

Kannus P, Parkkari J, Sievanen H, Heinonen A, Vuori I, Jarvinen M. Epidemiology of hip fractures. Bone. 1996;18:57S–63S. doi:10.1016/8756-3282(95)00381-9.PubMedCrossRef

15.

Cooper C. Epidemiology and public health impact of osteoporosis. Baillieres Clin Rheumatol. 1993;7:459–77. doi:10.1016/S0950-3579(05)80073-1.PubMedCrossRef

16.

Day N, Oakes S, Luben R, Khaw KT, Bingham S, Welch A, et al. EPIC-Norfolk: study design and characteristics of the cohort. European Prospective Investigation of Cancer. Br J Cancer. 1999;80(Suppl 1):95–103.PubMed

17.

Cox DR, Oakes D. Analysis of survival data. London: Chapman and Hall; 1984.

18.

Royston P, Ambler G, Sauerbrei W. The use of fractional polynomials to model continuous risk variables in epidemiology. Int J Epidemiol. 1999;28:964–74. doi:10.1093/ije/28.5.964.PubMedCrossRef

19.

Harrell FE Jr, Lee KL, Califf RM, Pryor DB, Rosati RA. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984;3:143–52. doi:10.1002/sim.4780030207.PubMedCrossRef

20.

Hosmer DW, Lemeshow S. Applied survival analysis. New York: Wiley; 1999.

21.

Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV. Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporos Int. 2007;18:1109–17. doi:10.1007/s00198-007-0362-8.PubMedCrossRef

22.

Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV. Residual lifetime risk of fractures in women and men. J Bone Miner Res. 2007;22:781–8. doi:10.1359/jbmr.070315.PubMedCrossRef

23.

Abrahamsen B, Vestergaard P, Rud B, Barenholdt O, Jensen JE, Nielsen SP, et al. Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause: the Danish osteoporosis prevention study. J Bone Miner Res. 2006;21:796–800. doi:10.1359/jbmr.020604.PubMedCrossRef

24.

Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK. International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002;17:1237–44. doi:10.1359/jbmr.2002.17.7.1237.PubMedCrossRef

25.

Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996;312:1254–9.PubMed

26.

Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int. 2007;18:1033–46. doi:10.1007/s00198-007-0343-y.PubMedCrossRef

27.

Richards JB, Leslie WD, Joseph L, Siminoski K, Hanley DA, Adachi JD, et al. Changes to osteoporosis prevalence according to method of risk assessment. J Bone Miner Res. 2007;22:228–34. doi:10.1359/jbmr.061109.PubMedCrossRef

28.

Leslie WD, Siminoski K, Brown JP. Comparative effects of densitometric and absolute fracture risk classification systems on projected intervention rates in postmenopausal women. J Clin Densitom. 2007;10:124–31. doi:10.1016/j.jocd.2007.01.003.PubMedCrossRef

29.

Jackson SA, Tenenhouse A, Robertson L. Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int. 2000;11:680–7. doi:10.1007/s001980070066.PubMedCrossRef

30.

Leslie WD, Metge C. Establishing a regional bone density program: lessons from the Manitoba experience. J Clin Densitom. 2003;6:275–82. doi:10.1385/JCD:6:3:275.PubMedCrossRef

31.

Khaw KT, Reeve J, Luben R, Bingham S, Welch A, Wareham N, et al. Prediction of total and hip fracture risk in men and women by quantitative ultrasound of the calcaneus: EPIC-Norfolk prospective population study. Lancet. 2004;363:197–202. doi:10.1016/S0140-6736(03)15325-1.PubMedCrossRef

Title: Estimation of absolute fracture risk among middle-aged and older men and women: the EPIC-Norfolk population cohort study
Authors: Alireza Moayyeri
Stephen Kaptoge
Robert N. Luben
Nicholas J. Wareham
Sheila Bingham
Jonathan Reeve
Kay Tee Khaw
Publication date: 01-05-2009
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 5/2009
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-009-9337-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Estimation of absolute fracture risk among middle-aged and older men and women: the EPIC-Norfolk population cohort study

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2009

Mediation and mechanism

Validity of coronary heart diseases and heart failure based on hospital discharge and mortality data in the Netherlands using the cardiovascular registry Maastricht cohort study

Adherence to the Mediterranean diet is associated with a lower risk of body-shape changes in Croatian patients treated with combination antiretroviral therapy

Different measures of social class in women and mortality

Examining secular trends and seasonality in count data using dynamic generalized linear modelling: a new methodological approach illustrated with hospital discharge data on myocardial infarction

Gender aspects on heart failure incidence and mortality in a middle-aged, urban, community-based population sample: the Malmö preventive project