TY - JOUR
T1 - A Risk Assessment Tool for Predicting Fragility Fractures and Mortality in the Elderly
AU - Tran, Thach
AU - Bliuc, Dana
AU - Pham, Hanh M.
AU - van Geel, Tineke
AU - Adachi, Jonathan D.
AU - Berger, Claudie
AU - van den Bergh, Joop
AU - Eisman, John A.
AU - Geusens, Piet
AU - Goltzman, David
AU - Hanley, David A.
AU - Josse, Robert G.
AU - Kaiser, Stephanie M.
AU - Kovacs, Christopher S.
AU - Langsetmo, Lisa
AU - Prior, Jerilynn C.
AU - Nguyen, Tuan
AU - Center, Jacqueline R.
AU - CaMos Research Group
PY - 2020/10
Y1 - 2020/10
N2 - Existing fracture risk assessment tools are not designed to predict fracture-associated consequences, possibly contributing to the current undermanagement of fragility fractures worldwide. We aimed to develop a risk assessment tool for predicting the conceptual risk of fragility fractures and its consequences. The study involved 8965 people aged >= 60 years from the Dubbo Osteoporosis Epidemiology Study and the Canadian Multicentre Osteoporosis Study. Incident fracture was identified from X-ray reports and questionnaires, and death was ascertained though contact with a family member or obituary review. We used a multistate model to quantify the effects of the predictors on the transition risks to an initial and subsequent incident fracture and mortality, accounting for their complex interrelationships, confounding effects, and death as a competing risk. There were 2364 initial fractures, 755 subsequent fractures, and 3300 deaths during a median follow-up of 13 years (interquartile range [IQR] 7-15). The prediction model included sex, age, bone mineral density, history of falls within 12 previous months, prior fracture after the age of 50 years, cardiovascular diseases, diabetes mellitus, chronic pulmonary diseases, hypertension, and cancer. The model accurately predicted fragility fractures up to 11 years of follow-up and post-fracture mortality up to 9 years, ranging from 7 years after hip fractures to 15 years after non-hip fractures. For example, a 70-year-old woman with aT-score of -1.5 and without other risk factors would have 10% chance of sustaining a fracture and an 8% risk of dying in 5 years. However, after an initial fracture, her risk of sustaining another fracture or dying doubles to 33%, ranging from 26% after a distal to 42% post hip fracture. A robust statistical technique was used to develop a prediction model for individualization of progression to fracture and its consequences, facilitating informed decision making about risk and thus treatment for individuals with different risk profiles. (c) 2020 American Society for Bone and Mineral Research.
AB - Existing fracture risk assessment tools are not designed to predict fracture-associated consequences, possibly contributing to the current undermanagement of fragility fractures worldwide. We aimed to develop a risk assessment tool for predicting the conceptual risk of fragility fractures and its consequences. The study involved 8965 people aged >= 60 years from the Dubbo Osteoporosis Epidemiology Study and the Canadian Multicentre Osteoporosis Study. Incident fracture was identified from X-ray reports and questionnaires, and death was ascertained though contact with a family member or obituary review. We used a multistate model to quantify the effects of the predictors on the transition risks to an initial and subsequent incident fracture and mortality, accounting for their complex interrelationships, confounding effects, and death as a competing risk. There were 2364 initial fractures, 755 subsequent fractures, and 3300 deaths during a median follow-up of 13 years (interquartile range [IQR] 7-15). The prediction model included sex, age, bone mineral density, history of falls within 12 previous months, prior fracture after the age of 50 years, cardiovascular diseases, diabetes mellitus, chronic pulmonary diseases, hypertension, and cancer. The model accurately predicted fragility fractures up to 11 years of follow-up and post-fracture mortality up to 9 years, ranging from 7 years after hip fractures to 15 years after non-hip fractures. For example, a 70-year-old woman with aT-score of -1.5 and without other risk factors would have 10% chance of sustaining a fracture and an 8% risk of dying in 5 years. However, after an initial fracture, her risk of sustaining another fracture or dying doubles to 33%, ranging from 26% after a distal to 42% post hip fracture. A robust statistical technique was used to develop a prediction model for individualization of progression to fracture and its consequences, facilitating informed decision making about risk and thus treatment for individuals with different risk profiles. (c) 2020 American Society for Bone and Mineral Research.
KW - FRAGILITY FRACTURE
KW - MORTALITY
KW - MULTISTATE PREDICTION MODEL
KW - OSTEOPOROSIS
KW - SUBSEQUENT FRACTURE
KW - CANADIAN MULTICENTER OSTEOPOROSIS
KW - HIP FRACTURE
KW - MULTISTATE MODELS
KW - POSTMENOPAUSAL WOMEN
KW - VERTEBRAL FRACTURE
KW - MEN
KW - DENSITY
KW - CHOICE
KW - CANCER
U2 - 10.1002/jbmr.4100
DO - 10.1002/jbmr.4100
M3 - Article
C2 - 32460361
SN - 0884-0431
VL - 35
SP - 1923
EP - 1934
JO - Journal of Bone and Mineral Research
JF - Journal of Bone and Mineral Research
IS - 10
ER -