Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Osteoporosis International
Published in: Osteoporosis International 6/2020

01-06-2020 | Osteoporosis | Original Article

Testing a theoretical model of imminent fracture risk in elderly women: an observational cohort analysis of the Canadian Multicentre Osteoporosis Study

Authors: A. Papaioannou, J. D. Adachi, C. Berger, Y. Jiang, R. Barron, J. S. McGinley, R. J. Wirth, T. P. Anastassiades, K. S. Davison, D. A. Hanley, G. Ioannidis, S. M. Kaiser, C. S. Kovacs, W. D. Leslie, S. N. Morin, J. C. Prior, T. Towheed, D. Goltzman

Published in: Osteoporosis International | Issue 6/2020

Login to get access

Abstract

Summary

We examined the underlying relationship between fracture risk factors and their imminent risk. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher imminent fracture risk. Past year falls indirectly predicted imminent risk through physical functioning and general health.

Introduction

This study aimed to examine direct and indirect effects of several factors on imminent (1 year) fracture risk.

Methods

Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI).

Results

The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ2(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001).

Conclusions

We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.
Footnotes
1
Note, the terms “direct effect” and “indirect effect” are standard terms used in SEM to describe the relationship between variables. If a relationship is observed “directly” between two variables it is a “direct effect”. If a relationship is mediated by one or more variables, it is an “indirect effect.” The term “effect” is not intended to suggest a causal relationship.
 
Literature
1.
Singer A, Exuzides A, Spangler L, O’Malley C, Colby C, Johnston K, Agodoa I, Baker J, Kagan R (2015) Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. In: Mayo Clinic Proceedings, vol 1. Elsevier, pp 53–62
2.
de Luise C, Brimacombe M, Pedersen L, Sørensen HT (2008) Comorbidity and mortality following hip fracture: a population-based cohort study. Aging Clin Exp Res 20(5):412–418CrossRef
3.
Solomon DH, Johnston SS, Boytsov NN, McMorrow D, Lane JM, Krohn KD (2014) Osteoporosis medication use after hip fracture in US patients between 2002 and 2011. J Bone Miner Res 29(9):1929–1937CrossRef
4.
Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, Shane E (2017) Addressing the crisis in the treatment of osteoporosis: a path forward. J Bone Miner Res 32(3):424–430CrossRef
5.
Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. Can Med Assoc J 182(17):1864–1873CrossRef
6.
Yusuf AA, Matlon TJ, Grauer A, Barron R, Chandler D, Peng Y (2016) Utilization of osteoporosis medication after a fragility fracture among elderly Medicare beneficiaries. Arch Osteoporos 11(1):31CrossRef
7.
Roux C, Briot K (2017) Imminent fracture risk. Osteoporos Int:1–5
8.
Alami S, Hervouet L, Poiraudeau S, Briot K, Roux C (2016) Barriers to effective postmenopausal osteoporosis treatment: a qualitative study of patients’ and practitioners’ views. PLoS One 11(6):e0158365CrossRef
9.
Kanis JA, Harvey NC, Cooper C, Johansson H, Odén A, McCloskey EV (2016) A systematic review of intervention thresholds based on FRAX. Arch Osteoporos 11(1):25CrossRef
10.
Siris E, Delmas P (2008) Assessment of 10-year absolute fracture risk: a new paradigm with worldwide application. Springer,
11.
Kanis JA, Harvey NC, Johansson H, Odén A, McCloskey EV, Leslie WD (2017) Overview of fracture prediction tools. J Clin Densitom
12.
Bonafede M, Shi N, Barron R, Li X, Crittenden D, Chandler D (2016) Predicting imminent risk for fracture in patients aged 50 or older with osteoporosis using US claims data. Arch Osteoporos 11(1):26CrossRef
13.
Johansson H, Siggeirsdóttir K, Harvey NC, Odén A, Gudnason V, McCloskey E, Sigurdsson G, Kanis JA (2017) Imminent risk of fracture after fracture. Osteoporos Int 28(3):775–780CrossRef
14.
van Geel TA, van Helden S, Geusens PP, Winkens B, Dinant G-J (2009) Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis 68(1):99–102CrossRef
15.
O’Hanlon CE, Parthan A, Kruse M, Cartier S, Stollenwerk B, Jiang Y, Caloyeras JP, Crittenden DB, Barron R (2017) A model for assessing the clinical and economic benefits of bone-forming agents for reducing fractures in postmenopausal women at high, near-term risk of osteoporotic fracture. Clin Ther 39(7):1276–1290CrossRef
16.
Cosman F, Nieves JW, Dempster DW (2017) Treatment sequence matters: anabolic and antiresorptive therapy for osteoporosis. J Bone Miner Res 32(2):198–202CrossRef
17.
18.
Cosman F, Miller PD, Williams GC, Hattersley G, Hu M-Y, Valter I, Fitzpatrick LA, Riis BJ, Christiansen C, Bilezikian JP (2017) Eighteen months of treatment with subcutaneous abaloparatide followed by 6 months of treatment with alendronate in postmenopausal women with osteoporosis: results of the ACTIVExtend trial. In: Mayo Clinic Proceedings, vol 2. Elsevier, pp 200–210
19.
Cosman F, Crittenden DB, Adachi JD, Binkley N, Czerwinski E, Ferrari S, Hofbauer LC, Lau E, Lewiecki EM, Miyauchi A (2016) Romosozumab treatment in postmenopausal women with osteoporosis. N Engl J Med 375(16):1532–1543CrossRef
20.
Hippisley-Cox J, Coupland C (2012) Derivation and validation of updated QFracture algorithm to predict risk of osteoporotic fracture in primary care in the United Kingdom: prospective open cohort study. Bmj 344:e3427CrossRef
21.
22.
Nguyen ND, Frost SA, Center J, Eisman JA, Nguyen TV (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19(10):1431–1444CrossRef
23.
van Geel TA, Eisman JA, Geusens PP, van den Bergh JP, Center JR, Dinant G-J (2014) The utility of absolute risk prediction using FRAX® and Garvan fracture risk calculator in daily practice. Maturitas 77(2):174–179CrossRef
24.
Duncan OD (2014) Introduction to structural equation models. Elsevier,
25.
Acock AC (2013) Discovering structural equation modeling using Stata. Stata Press books
26.
Kreiger N, Tenenhouse A, Joseph L, Mackenzie T, Poliquin S, Brown JP, Prior JC, Rittmaster RS (1999) The Canadian multicentre osteoporosis study (CaMos): background, rationale, methods. Canadian Journal on Aging/La Revue canadienne du vieillissement 18(3):376–387CrossRef
27.
Ware Jr JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection Med Care:473–483
28.
Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16(3):297–334CrossRef
29.
Muthñn L, Muthñn B (2012) Mplus. Statistical analysis with latent variables User’s guide seventh edition. Muthñn & Muthñn, Los Angeles
30.
Wirth R, Edwards MC (2007) Item factor analysis: current approaches and future directions. Psychol Methods 12(1):58–79CrossRef
31.
Browne MW, Cudeck R (1989) Single sample cross-validation indices for covariance structures. Multivar Behav Res 24(4):445–455CrossRef
32.
Hu L, Bentler PM (1999) Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J 6(1):1–55CrossRef
33.
Balasubramanian A, Zhang J, Chen L, Wenkert D, Daigle S, Grauer A, Curtis J (2019) Risk of subsequent fracture after prior fracture among older women. Osteoporos Int 30(1):79–92CrossRef
34.
Miller PD, Hattersley G, Riis BJ, Williams GC, Lau E, Russo LA, Alexandersen P, Zerbini CA, Hu M-y, Harris AG (2016) Effect of abaloparatide vs placebo on new vertebral fractures in postmenopausal women with osteoporosis: a randomized clinical trial. Jama 316(7):722–733CrossRef
35.
Kendler DL, Marin F, Zerbini CA, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A (2017) Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet
36.
Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18(11):1947–1954CrossRef
Metadata
Title
Testing a theoretical model of imminent fracture risk in elderly women: an observational cohort analysis of the Canadian Multicentre Osteoporosis Study
Authors
A. Papaioannou
J. D. Adachi
C. Berger
Y. Jiang
R. Barron
J. S. McGinley
R. J. Wirth
T. P. Anastassiades
K. S. Davison
D. A. Hanley
G. Ioannidis
S. M. Kaiser
C. S. Kovacs
W. D. Leslie
S. N. Morin
J. C. Prior
T. Towheed
D. Goltzman
Publication date
01-06-2020
Publisher
Springer London
Published in
Osteoporosis International / Issue 6/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-020-05330-2

Other articles of this Issue 6/2020

Osteoporosis International 6/2020 Go to the issue

Correction

Correction to: Comprehensive genetic analyses using targeted next-generation sequencing and genotype-phenotype correlations in 53 Japanese patients with osteogenesis imperfecta

Original Article

Kyphosis and 3-year fall risk in community-dwelling older men

Correction

Correction to: Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial

Letter to the Editor

Letter to the editor about the article “Different surgical outcomes in a patient with bilateral atypical femoral fracture related to bisphosphonate use with or without teriparatide treatment”

Original Article

Insulin resistance negatively affects bone quality not quantity: the relationship between bone and adipose tissue

Review

Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis