Published in:
01-12-2019 | Osteoporosis | Original Article
Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos)
Authors:
Jonathan D. Adachi, Claudie Berger, Rich Barron, Derek Weycker, Tassos P. Anastassiades, K. Shawn Davison, David A. Hanley, George Ioannidis, Stuart A. Jackson, Robert G. Josse, Stephanie M. Kaiser, Christopher S. Kovacs, William D. Leslie, Suzanne N. Morin, Alexandra Papaioannou, Jerilynn C. Prior, Erinda Shyta, Amanda Silvia, Tanveer Towheed, David Goltzman
Published in:
Archives of Osteoporosis
|
Issue 1/2019
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Abstract
Summary
Using data from the Canadian Multicentre Osteoporosis Study, several risk factors predictive of imminent (2-year) risk of low-trauma non-vertebral fracture among high-risk women were identified, including history of falls, history of low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to targeting this population for therapy.
Purpose
Fracture risk assessment has focused on a long-term horizon and populations with a broad risk range. For elderly women with osteoporosis or low bone mass, or a history of fragility fractures (“high-risk women”), risk prediction over a shorter horizon may have greater clinical relevance.
Methods
A repeated-observations design and data from the Canadian Multicentre Osteoporosis Study were employed. Study population comprised women aged ≥ 65 years with T score (total hip, femoral neck, spine) ≤ − 1.0 or prior fracture. Hazard ratios (HR) for predictors of low-trauma non-vertebral fracture during 2-year follow-up were estimated using multivariable shared frailty model.
Results
The study population included 3228 women who contributed 5004 observations; 4.8% experienced low-trauma non-vertebral fracture during the 2-year follow-up. In bivariate analyses, important risk factors included age, back pain, history of falls, history of low-trauma fracture, physical function, health status, and total hip T score. In multivariable analyses, only four independent predictors were identified: falls in past 12 months (≥ 2 falls: HR = 1.9; 1 fall: HR = 1.5), low-trauma fracture in past 12 months (≥ 1 fracture: HR = 1.7), SF-36 physical component summary score (≤ 42.0: HR = 1.6), and total hip T score (≤ − 3.5: HR = 3.7; > − 3.5 to ≤ − 2.5: HR = 2.5; > − 2.5 to ≤ − 1: HR = 1.3).
Conclusions
Imminent risk of low-trauma non-vertebral fracture is elevated among high-risk women with a history of falls or low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to identifying and targeting this population for therapy.