Femoral neck bone mineral density and 10-year absolute fracture risk in a national representative sample of Bulgarian women aged 50?years and older

Summary

This study explored the epidemiology of osteoporosis in Bulgarian women (>50?years). Of the women included in the study, 16.8% had osteoporosis and 46.5% had osteopenia at the femoral neck. The mean 10-year absolute fracture risk was 13.4?±?9.2% (major fractures) and 2.8?±?5.2% (hip fractures). This study is the largest Bulgarian epidemiological osteoporosis trial.

Purpose

The aim of this study was to determine the prevalence of the major risk factors for osteoporosis and the 10-year absolute fracture risk in a national representative sample of Bulgarian women aged 50 and older.

Methods

This work is a part of the Bulgarian Osteoporosis Epidemiology Study. The National Statistical Institute selected a national representative epidemiological sample. A questionnaire was used allowing fracture risk calculation according to FRAX. Ten osteoporosis centers throughout the country participated. Bone mineral density (BMD) was measured at the femoral neck by dual X-ray absorptiometry. The statistical analysis was performed on a SPSS 13.0 for windows platform.

Results

A total of 1,331 women were included (mean age 63.8?±?8.3?years), divided into decades. Of them, 16.8% had osteoporosis and 46.5% had low femoral neck BMD. Their mean 10-year absolute fracture risk for major fractures was 13.4?±?9.2%, and for hip fractures 2.8?±?5.2%, respectively. The prevalence of some major risk factors for osteoporosis was as follows: height loss?>?3?cm??33.1% of all women; family history of hip fractures??4.1%; previous hip fractures??1.9%; previous vertebral fractures??2.3%; all fractures??23.3%; smoking??11.9%.

Conclusions

This study is the largest epidemiological osteoporosis trial in Bulgaria to date and allows assumptions about the prevalence of osteoporosis and fractures among women aged 50 and older in our country.     

Failure to perceive increased risk of fracture in women 55?years and older: the Global Longitudinal Study of Osteoporosis in Women (GLOW)

Summary

We compared self-perception of fracture risk with actual risk among 60,393 postmenopausal women aged ??55?years, using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Most postmenopausal women with risk factors failed to appreciate their actual risk for fracture. Improved education about osteoporosis risk factors is needed.

Introduction

This study seeks to compare self-perception of fracture risk with actual risk among postmenopausal women using data from GLOW.

Methods

GLOW is an international, observational, cohort study involving 723 physician practices in 17 sites in ten countries in Europe, North America, and Australia. Participants included 60,393 women ??55?years attended by their physician during the previous 24?months. The sample was enriched so that two thirds were ??65?years. Baseline surveys were mailed October 2006 to February 2008. Main outcome measures were self-perception of fracture risk in women with elevated risk vs women of the same age and frequency of risk factors for fragility fracture.

Results

In the overall study population, 19% (10,951/58,434) of women rated their risk of fracture as a little/much higher than that of women of the same age; 46% (27,138/58,434) said it was similar; 35% (20,345/58,434) believed it to be a little/much lower. Among women whose actual risk was increased based on the presence of any one of seven risk factors for fracture, the proportion who recognized their increased risk ranged from 19% for smokers to 39% for current users of glucocorticoid medication. Only 33% (4,185/12,612) of those with ??2 risk factors perceived themselves as being at higher risk. Among women reporting a diagnosis of osteopenia or osteoporosis, only 25% and 43%, respectively, thought their risk was increased.

Conclusion

In this international, observational study, most postmenopausal women with risk factors failed to appreciate their actual risk for fracture.     

Phalangeal bone mineral density predicts incident fractures: a prospective cohort study on men and women—results from the Danish Health Examination Survey 2007–2008 (DANHES 2007–2008)

Summary

This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures.

Purpose

The aim of this study was to evaluate the ability of a compact and portable scanner using radiographic absorptiometry (RA) to predict major osteoporotic fractures.

Methods

This prospective study included a cohort of 15,542 men and women aged 18?C95?years, who underwent a BMD scan in Danish Health Examination Survey 2007?C2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan?). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International Classification of Diseases (ICD-10). Follow-up was 27?C45?months. Major osteoporotic fractures (vertebral fractures, humerus fractures, forearm fractures and hip fractures) were used in the analyses. Fracture events were calculated as ??persons with fracture?? and evaluated using survival analysis.

Results

A total of 307 (1.98?%) of the participants had experienced a new fracture during follow-up. BMD was significantly lower in subjects with fracture (0.32 vs. 0.34?g/cm²; p?<?0.001 adjusted for age, gender, prevalent fractures, height, weight and smoking). In both women and men, a 1 SD decrease in BMD (T score units) was associated with an increased risk of fracture when adjusted for age and prevalent fractures (women: HR?=?1.39, CI 1.24?C1.54, p?<?0.001; men: HR?=?1.47, CI 1.20?C1.79, p?<?0.001).

Conclusion

Phalangeal BMD as measured using RA predicts the incidence of major osteoporotic fractures.     

Construction of a FRAX? model for the assessment of fracture probability in Canada and implications for treatment

Summary

We describe the creation of a FRAX? model for the assessment of fracture probability in Canadian men and women, calibrated from national hip fracture and mortality data. This FRAX tool was used to examine possible thresholds for therapeutic intervention in Canada in two large complementary cohorts of women and men.

Objective

To evaluate a Canadian World Health Organization (WHO) fracture risk assessment (FRAX?) tool for computing 10-year probabilities of osteoporotic fracture.

Methods

Fracture probabilities were computed from national hip fracture data (2005) and death hazards (2004) for Canada. Probabilities took account of age, sex, clinical risk factors (CRFs), and femoral neck bone mineral density (BMD). Treatment implications were studied in two large cohorts of individuals age 50?years and older: the population-based Canadian Multicentre Osteoporosis Study (4,778 women and 1,919 men) and the clinically referred Manitoba BMD Cohort (36,730 women and 2,873 men).

Results

Fracture probabilities increased with age, decreasing femoral neck T-score, and number of CRFs. Among women, 10.1?C11.3% would be designated high risk based upon 10-year major osteoporotic fracture probability exceeding 20%. A much larger proportion would be designated high risk based upon 10-year hip fracture probability exceeding 3% (25.7?C28.0%) or osteoporotic BMD (27.1?C30.9%), and relatively few from prior hip or clinical spine fracture (1.6?C4.2%). One or more criteria for intervention were met by 29.2?C34.0% of women excluding hip fracture probability (35.3?C41.0% including hip fracture probability). Lower intervention rates were seen among CaMos (Canadian Multicentre Osteoporosis Study) men (6.8?C12.9%), but in clinically referred men from the Manitoba BMD Cohort, one or more criteria for high risk were seen for 26.4% excluding hip fracture probability (42.4% including hip fracture probability).

Conclusions

The FRAX tool can be used to identify intervention thresholds in Canada. The FRAX model supports a shift from a dual X-ray absorptiometry (DXA)-based intervention strategy, towards a strategy based on fracture probability for a major osteoporotic fracture.     

Quantitative ultrasound and fracture risk prediction in non-osteoporotic men and women as defined by WHO criteria

Summary

This study sought to determine the association between calcaneal quantitative ultrasound (QUS) and fracture risk in individuals without osteoporosis according to the World Health Organization criteria (i.e., BMD T-score?>??2.5). We found that calcaneal QUS is an independent predictor of fracture risk in women with non-osteoporotic bone mineral density (BMD).

Introduction

More than 50 % of women and 70 % of men who sustain a fragility fracture have BMD above the osteoporotic threshold (T-score?>??2.5). Calcaneal QUS is associated with fracture risk. This study aimed to test the hypothesis that low calcaneal QUS is associated with increased fracture risk in individuals with non-osteoporotic BMD.

Methods

We included 312 women and 390 men aged 62–90 years with BMD T-score?>??2.5 at femoral neck. QUS was measured in broadband ultrasound attenuation (BUA) at the calcaneus using a CUBA sonometer. BMD was measured at the femoral neck (FNBMD) by dual energy X-ray absorptiometry using GE Lunar DPX-L densitometer. The incidences of any fragility fracture were ascertained by X-ray reports during the follow-up period from 1994 to 2011.

Results

Of the 702 participants, 26 % of women (n?=?80/312) and 14 % of men (n?=?53/390) experienced at least one fragility fracture during the follow-up period. In women, after adjusting for covariates, increased risk of any fracture was significantly associated with decreased BUA (HR?=?1.50; 95 % CI, 1.13–1.99). Compared with that of FNBMD, the models with BUA, in women, had greater AUC (0.71, 0.85, 0.71 for any, hip and vertebral fracture, respectively), and yielded a net reclassification improvement of 16.4 % (P?=?0.009) when combined with FNBMD. In men, BUA was not significantly associated with fracture risk before and after adjustment.

Conclusion

These results suggest that calcaneal BUA is an independent predictor of fracture risk in women with non-osteoporotic BMD.     

Cost-effective intervention thresholds against osteoporotic fractures based on FRAX? in Switzerland

Summary

FRAX-based cost-effective intervention thresholds in the Swiss setting were determined. Assuming a willingness to pay at 2× Gross Domestic Product per capita, an intervention aimed at reducing fracture risk in women and men with a 10-year probability for a major osteoporotic fracture at or above 15% is cost-effective.

Introduction

The fracture risk assessment algorithm FRAX? has been recently calibrated for Switzerland. The aim of the present analysis was to determine FRAX-based fracture probabilities at which intervention becomes cost-effective.

Methods

A previously developed and validated state transition Markov cohort model was populated with Swiss epidemiological and cost input parameters. Cost-effective FRAX-based intervention thresholds (cost-effectiveness approach) and the cost-effectiveness of intervention with alendronate (original molecule) in subjects with a FRAX-based fracture risk equivalent to that of a woman with a prior fragility fracture and no other risk factor (translational approach) were calculated based on the Swiss FRAX model and assuming a willingness to pay of 2 times Gross Domestic Product per capita for one Quality-adjusted Life-Year.

Results

In Swiss women and men aged 50?years and older, drug intervention aimed at decreasing fracture risk was cost-effective with a 10-year probability for a major osteoporotic fracture at or above 13.8% (range 10.8% to 15.0%) and 15.1% (range 9.9% to 19.9%), respectively. Age-dependent variations around these mean values were modest. Using the translational approach, treatment was cost-effective or cost-saving after the age 60?years in women and 55 in men who had previously sustained a fragility fracture. Using the latter approach leads to considerable underuse of the current potential for cost-effective interventions against fractures.

Conclusions

Using a FRAX-based intervention threshold of 15% for both women and men should permit cost-effective access to therapy to patients at high fracture probability based on clinical risk factors and thereby contribute to further reduce the growing burden of osteoporotic fractures in Switzerland.     

Albuminuria is associated with hip fracture risk in older adults: the cardiovascular health study

Summary

The microcirculation plays an important role in bone health. Here, we examine whether albuminuria, a marker of renal microvascular disease, is associated with the risk of hip fracture in older adults (age, 78 years). We find a small independent association in women but not in men.

Introduction

The microvascular circulation plays an important role in bone physiology. Two studies of middle-aged adults have found that albuminuria (>30 mg albumin/g creatinine), a disorder of the renal microvasculature, is associated with fracture risk. Here, we examine whether albuminuria is related to hip fracture risk and reduced hip bone mineral density (BMD) in older adults with a mean age of 78 years.

Methods

From the Cardiovascular Health Study (41 % male), 3,110 adults with albuminuria testing were followed up for incident hip fracture for up to 9.5 years. BMD was performed in a subset of 1,208 participants.

Results

There were 313 hip fractures during follow-up (7.7 % of men; 11.7 % of women). The incidence rate for men, with and without albuminuria, was 1.43 and 0.93/100 person-years of follow-up (p?=?0.02); for women, 1.84 and 1.33 (p?=?0.04). After adjustment for osteoporosis-related factors, frailty and falling, a doubling of albuminuria was significantly associated with hip fracture risk in women (hazard ratio, 1.12, 95 % CI, 1.001–1.25), but not in men. In the subcohort with BMD measurement, increased urine albumin levels were significantly associated with decreased total hip BMD in men (?0.009 g calcium/cm² (?0.017, ?0.001); p?=?0.04), but not in women.

Conclusions

In older women, albuminuria is associated with a small, but statistically significant, increased risk of hip fracture independent of other explanatory factors. No such risk appears to be present in men, although their total hip BMD is lower in association with albuminuria.     

Vertebral fracture risk (VFR) score for fracture prediction in postmenopausal women

Summary

Early prognosis of osteoporosis risk is not only important to individual patients but is also a key factor when screening for osteoporosis drug trial populations. We present an osteoporosis fracture risk score based on vertebral heights. The score separated individuals who sustained fractures (by follow-up after 6.3?years) from healthy controls at baseline.

Introduction

This case?Ccontrol study was designed to assess the ability of three novel fracture risk scoring methods to predict first incident lumbar vertebral fractures in postmenopausal women matched for classical risk factors such as BMD, BMI, and age.

Methods

This was a case?Ccontrol study of 126 postmenopausal women, 25 of whom sustained at least one incident lumbar fracture and 101 controls that maintained skeletal integrity over a 6.3-year period. Three methods for fracture risk assessment were developed and tested. They are based on anterior, middle, and posterior vertebral heights measured from vertebrae T12-L5 in lumbar radiographs at baseline. Each score??s fracture prediction potential was investigated in two variants using (1) measurements from the single most deformed vertebra or (2) average measurements across vertebrae T12-L5. Emphasis was given to the vertebral fracture risk (VFR) score.

Results

All scoring methods demonstrated significant separation of cases from controls at baseline. Specifically, for the VFR score, cases and controls were significantly different (0.67?±?0.04 vs. 0.35?±?0.03, p?<?10?^?6) with an AUC of 0.82. Dividing the VFR scores into tertiles, the fracture odds ratio for the highest versus lowest tertile was 35 (p?<?0.001). Sorting the combined case?Ccontrol group according to VFR score resulted in 90% of cases in the top half.

Conclusion

At baseline, the three scores separated cases from controls and, especially, the VFR score appears to be predictive of fractures. Control experiments, however also, indicate that VFR-based fracture prediction is operator/annotator dependent and high-quality annotations are needed for good fracture prediction     

Percentage of the population at high risk of osteoporotic fracture in South Korea: analysis of the 2010 Fifth Korean National Health and Nutrition Examination survey data

Summary

Osteoporosis and high-risk osteopenia (high-risk of osteoporotic fractures) are highly prevalent in South Korean postmenopausal women and men aged 50 years and over.

Introduction

This study determined the percentages of the population at high risk of osteoporotic fractures according to the World Health Organization (WHO) criteria and the Fracture Risk Assessment (FRAX) model.

Methods

Data collected from the 2010 Fifth Korean National Health and Nutrition Examination Survey, a cross-sectional survey of the general South Korean general population, were analyzed. The percentages of the population with high-risk osteopenia according to the US National Osteoporosis Foundation (NOF) and Japanese treatment guidelines were subsequently determined and compared.

Results

Based on the WHO criteria and FRAX model, 37.7 % of the menopausal women and 12.7 % of the men aged 50 years and older are at high risk of osteoporotic fracture. According to the Japanese and NOF guidelines, 10.9 (10.6 % of men and 11.2 % of women) and 10.7 % (10.6 % of men and 10.9 % of women), respectively, of the study population with osteopenia are at high risk of fracture. By age group, 49.3 % of Korean women aged 55 years and older, 67.7 % of Korean women aged 65 years and older, and 33.5 % of Korean men aged 75 years and older are at high risk.

Conclusion

As a very large percentage of the South Korean postmenopausal population has osteoporosis or high-risk osteopenia, greater effort at identifying and treating this population should be expended to prevent osteoporotic fracture.     

Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation guidance

Summary

This analysis of National Health and Nutrition Examination Survey III data found a significant risk of incident hip fracture in adults aged 65?years and older who are candidates for treatment to lower fracture risk, according to the new National Osteoporosis Foundation Clinician's Guide.

Introduction

The relationship between treatment eligibility by the new National Osteoporosis Foundation (NOF) Guide to the Prevention and Treatment of Osteoporosis and the risk of subsequent hip fracture is unknown.

Methods

The study sample consisted of 3,208 men and women ages 65?years and older who were examined in the third National Health and Nutrition Examination Survey (NHANES III, 1988?C1994), a nationally representative survey. Risk factors used to define treatment eligibility at baseline were measured in NHANES III or were simulated using World Health Organization study cohorts. Incident hip fractures were ascertained using linked mortality and Medicare records that were obtained for NHANES III participants through December 31, 2000. Cox proportional hazards models were used to estimate the relative risk (RR) of hip fracture by treatment eligibility status.

Results

The RR for subsequent hip fracture was 4.9 (95% CI 3.30, 7.94) in treatment-eligible vs treatment-ineligible persons. The increased risk for treatment-eligible persons remained statistically significant when examined by sex or age: RR_men?=?5.5 (2.6, 11.4) and RR_women?=?4.3 (2.2, 8.4); RR_{65-79 y}?=?4.8 (2.6, 8.7) and RR_{80+ y}?=?4.6 (2.1, 10.1).

Conclusions

Treatment-eligible persons were about five times more likely to experience a subsequent hip fracture than the non-eligible persons. The new NOF guidelines appear to predict future hip fracture risk equally in men as in women, and fracture risk prediction did not appear to diminish with age.     

Population-based Canadian hip fracture rates with international comparisons

Summary

We identified hospitalizations throughout Canada during 2000–2005 in which the most responsible diagnosis was a proximal femoral fracture. Use of the US fracture risk assessment tool (FRAX) would be inappropriate for Canada as it would overestimate fracture risk in Canadian women and older men.

Introduction

It is recommended that the WHO fracture risk assessment tool should be calibrated to the target population.

Methods

We identified hospitalizations for women and men throughout Canada during the study period 2000–2005 in which the most responsible diagnosis was a proximal femoral fracture (147,982 hip fractures). Age-standardized hip fracture rates were compared between Canadian provinces, and national rates were compared with those reported for the USA and Germany.

Results

There were relatively small differences in hip fracture rates between provinces, and most did not differ appreciably from the Canadian average. Hip fracture rates for women in Canada in 2001 were substantially lower than in the USA (population-weighted rate ratio 0.70) and were also lower than in Germany for 2004 (population-weighted rate ratio 0.74).

Conclusions

Overall hip fracture rates for Canadian women were found to be substantially lower than those for the USA and Germany. This study underscores the importance of assessing country-specific fracture patterns prior to adopting an existing FRAX tool.     

The impact of a FRAX-based intervention threshold in Turkey: the FRAX-TURK study

Introduction

With the development of country-specific FRAX? tools to estimate fracture probability, guidance is required on the fracture probability at which treatment can be recommended.

Objectives

The aim of the present study was to determine FRAX-based intervention thresholds in men and women from Turkey and determine their population impact.

Patients and methods

Intervention thresholds for treatment and assessment thresholds for measuring BMD were devised using the strategy adopted by the National Osteoporosis Guideline Group of the UK but applied to the fracture probabilities in Turkey. The number of men and women potentially eligible for treatment was determined from the distribution of FRAX-based probabilities of a major fracture (Turkish model, version 3.6) in a representative sample of 26,394 men and women aged 50?years or more.

Results

Intervention thresholds, set at the probability equivalents of a woman with a prior fragility fracture rose with age from 7.0?% at the age of 50?years to 31?% at the age of 90?years. Approximately 8.6?% of the female Turkish population aged 50?years or more had a prior fragility fracture and would be eligible for treatment. A further 13.6?% without a prior fracture would be eligible for treatment. In contrast, the number of men aged 50?years or more eligible for treatment was 3.1?%

Conclusions

FRAX-based guidelines can be developed and are expected to avoid unnecessary treatment of individuals at low fracture risk and direct treatments to those at high risk. The adoption of FRAX-based intervention thresholds will demand a reappraisal of the criteria for reimbursement of interventions and health economic assessment.     

Institutionalization following incident non-traumatic fractures in community-dwelling men and women

Summary

Institutionalization after hip fracture occurs in at least 30% of patients in the year following hospital discharge. We demonstrate that the risk of transfer to a long-term care facility, after adjustment for age and burden of co-morbidity, is also increased following fractures at other osteoporotic sites in men and women. For most fractures, men are at greater risk than women.

Introduction

High institutionalization rates have been documented following non-traumatic hip fractures; however, there is lack of knowledge regarding the frequency of transfer to long-term care institutions of patients who sustain such fractures at other anatomical sites.

Methods

Using the comprehensive health care databases of the province of Manitoba, Canada, we performed a retrospective matched cohort study of community-dwelling men and women aged 50?years and older who sustained an incident non-traumatic fracture between April 1, 1986, and March 31, 2006. Using Cox proportional hazards regression analysis, we estimated the sex-specific relative risk of transfers to long-term care institutions in the year following fracture at osteoporotic sites.

Results

We identified a total of 70,264 individuals with incident fractures (70.0% in women) among whom 3,996 new admissions to long-term care institutions were documented in the year following the index fracture. New admissions increased over time (p?p?Conclusions Non-traumatic fractures at any site have serious consequences, including institutionalization. Men are at greater risk of transfer to long-term care following fracture than women.     

The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group

Summary

Osteoporosis causes an elevated fracture risk. We propose the continued use of T-scores as one means for diagnosis but recommend that, alternatively, hip fracture; osteopenia-associated vertebral, proximal humerus, pelvis, or some wrist fractures; or FRAX scores with ≥3 % (hip) or 20 % (major) 10-year fracture risk also confer an osteoporosis diagnosis.

Introduction

Osteoporosis is a common disorder of reduced bone strength that predisposes to an increased risk for fractures in older individuals. In the USA, the standard criterion for the diagnosis of osteoporosis in postmenopausal women and older men is a T-score of?≤??2.5 at the lumbar spine, femur neck, or total hip by bone mineral density testing.

Methods

Under the direction of the National Bone Health Alliance, 17 clinicians and clinical scientists were appointed to a working group charged to determine the appropriate expansion of the criteria by which osteoporosis can be diagnosed.

Results

The group recommends that postmenopausal women and men aged 50 years should be diagnosed with osteoporosis if they have a demonstrable elevated risk for future fractures. This includes having a T-score of less than or equal to ?2.5 at the spine or hip as one method for diagnosis but also permits a diagnosis for individuals in this population who have experienced a hip fracture with or without bone mineral density (BMD) testing and for those who have osteopenia by BMD who sustain a vertebral, proximal humeral, pelvic, or, in some cases, distal forearm fracture. Finally, the term osteoporosis should be used to diagnose individuals with an elevated fracture risk based on the World Health Organization Fracture Risk Algorithm, FRAX.

Conclusions

As new ICD-10 codes become available, it is our hope that this new understanding of what osteoporosis represents will allow for an appropriate diagnosis when older individuals are recognized as being at an elevated risk for fracture.     

The effect of psychological status on pain and surgical outcome in patients requiring arthroscopic subacromial decompression

Background

We prospectively investigated the association between pre-operative psychological status and early post-operative shoulder pain and function in patients requiring arthroscopic subacromial decompression for impingement syndrome.

Methods

A consecutive series of patients in 2009/10 completed questionnaires 2?weeks pre-operatively and three and 6?weeks post-operatively that assessed psychological state, shoulder function and pain. The hospital anxiety and depression scale, the oxford shoulder score and a pain visual analogue scale assessed psychological status, shoulder function and shoulder pain, respectively.

Results

Thirty-one patients participated (21 women; 10 men; mean age 54.6?years; age range 21–89?years). Pre-operative anxiety was significantly associated with pre-operative shoulder pain (P?<?0.05). Pre-operative psychological status did not correlate with post-operative shoulder pain or function. Greater pre-operative anxiety and depression were significantly associated with post-operative psychological distress (P?<?0.05). Overall shoulder pain, function and psychological state improved significantly during the study (P?<?0.05) regardless of pre-operative psychological status.

Conclusion

Despite pre-operative associations between anxiety and shoulder pain, there were no associations between pre-operative psychological status and post-operative outcomes. There may be no justification for assessing psychological state in cases of ‘uncomplicated’ impingement syndromes requiring arthroscopic subacromial decompression. Abnormal pre-operative psychological status is not a justifiable reason for delaying or denying this effective operation.     

Severity of aortic calcification is positively associated with vertebral fracture in older men—a densitometry study in the STRAMBO cohort

Summary

In older men, severe abdominal aortic calcification and vertebral fracture (both assessed using dual-energy X-ray absorptiometry) were positively associated after adjustment for confounders including bone mineral density.

Introduction

Abdominal aortic calcification (AAC) is associated with higher fracture risk, independently of low bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) can be used to assess both vertebral fracture and AAC and requires less time, cost, and radiation exposure.

Methods

We conducted a cross-sectional study of the association between AAC and prevalent vertebral fractures in 901 men ≥50 years old. We used DXA (vertebral fracture assessment) to evaluate BMD, vertebral fracture, and AAC.

Results

Prevalence of vertebral fracture was 11 %. Median AAC score was 1 and 12 % of men had AAC score >6. After adjustment for age, weight, femoral neck BMD, smoking, ischemic heart disease, diabetes, and hypertension, AAC score >6 (vs ≤6) was associated with 2.5 (95 % CI, 1.4–4.5) higher odds of vertebral fracture. Odds of vertebral fracture for AAC score >6 increased with vertebral fracture severity (grade 1, OR?=?1.8; grade 2, OR?=?2.4; grade 3, OR?=?4.4; trend p?<?0.01) and with the number of vertebral fractures (1 fracture, OR?=?2.0, >1 fracture, OR?=?3.5). Prevalence of vertebral fracture was twice as high in men having both a T-score?<??2.0 and an AAC score?>?6 compared with men having only one of these characteristics.

Conclusions

Men with greater severity AAC had greater severity and greater number of vertebral fractures, independently of BMD and co-morbidities. DXA can be used to assess vertebral fracture and AAC. It can provide a rapid, safe, and less expensive alternative to radiography. DXA may be an important clinical tool to identify men at high risk of adverse outcomes from osteoporosis and cardiovascular disease.     

Sex- and age-specific incidence of non-traumatic fractures in selected industrialized countries

Summary

Various methodological approaches have estimated the incidence of osteoporosis-related fractures, making comparisons difficult. This study estimated the incidence rates of non-traumatic fractures in 12 countries using standard definitions. Applying these rates to the 2010 population figures of these countries, a total of 5.2 million non-traumatic fractures were estimated, mostly in women.

Purpose

The purpose of this study was to estimate annual country-, sex-, and age-specific incidence of non-traumatic hip, vertebral, and other fractures for women aged ??50 and men ??60?years and the number of fractures expected in 12 countries based on these incidence rates.

Methods

Electronically indexed medical literature and relevant web sites were reviewed to identify studies reporting age- and sex-specific fracture incidence rates to obtain estimates of the proportion of fractures considered to be non-traumatic and to gather relevant census data. From these data, we extrapolated to estimate the number of fractures in 12 countries in North America, Europe, Japan, and Australia.

Results

Annual non-traumatic hip fracture incidence rates were highest for women in Sweden, Denmark, and Finland. In women, vertebral fractures were more common than hip fractures. The incidence of vertebral fractures was highest among Scandinavian and Canadian women. In men, Scandinavians had the highest incidence of hip fractures, while Australian men had the highest incidence of vertebral fractures. Hip and vertebral fracture incidence increased steeply with age for both women and men. Age appears to exert less influence on the incidence of fractures at sites other than hip and vertebrae. In 2010, 5.2 million non-traumatic fractures were expected in the 12 countries studied, of which 2.8 million were at the hip or spine. Women accounted for most of the total non-traumatic fracture burden (77?%).

Conclusions

Non-traumatic fractures pose a significant burden, affecting millions of women and men in countries around the world each year.     

Fracture prediction and calibration of a Canadian FRAX? tool: a population-based report from CaMos

Summary

A new Canadian WHO fracture risk assessment (FRAX?) tool to predict 10-year fracture probability was compared with observed 10-year fracture outcomes in a large Canadian population-based study (CaMos). The Canadian FRAX tool showed good calibration and discrimination for both hip and major osteoporotic fractures.

Introduction

The purpose of this study was to validate a new Canadian WHO fracture risk assessment (FRAX?) tool in a prospective, population-based cohort, the Canadian Multicentre Osteoporosis Study (CaMos).

Methods

A FRAX tool calibrated to the Canadian population was developed by the WHO Collaborating Centre for Metabolic Bone Diseases using national hip fracture and mortality data. Ten-year FRAX probabilities with and without bone mineral density (BMD) were derived for CaMos women (N?=?4,778) and men (N?=?1,919) and compared with observed fracture outcomes to 10?years (Kaplan?CMeier method). Cox proportional hazard models were used to investigate the contribution of individual FRAX variables.

Results

Mean overall 10-year FRAX probability with BMD for major osteoporotic fractures was not significantly different from the observed value in men [predicted 5.4% vs. observed 6.4% (95%CI 5.2?C7.5%)] and only slightly lower in women [predicted 10.8% vs. observed 12.0% (95%CI 11.0?C12.9%)]. FRAX was well calibrated for hip fracture assessment in women [predicted 2.7% vs. observed 2.7% (95%CI 2.2?C3.2%)] but underestimated risk in men [predicted 1.3% vs. observed 2.4% (95%CI 1.7?C3.1%)]. FRAX with BMD showed better fracture discrimination than FRAX without BMD or BMD alone. Age, body mass index, prior fragility fracture and femoral neck BMD were significant independent predictors of major osteoporotic fractures; sex, age, prior fragility fracture and femoral neck BMD were significant independent predictors of hip fractures.

Conclusion

The Canadian FRAX tool provides predictions consistent with observed fracture rates in Canadian women and men, thereby providing a valuable tool for Canadian clinicians assessing patients at risk of fracture.     

Trabecular bone score improves fracture risk prediction in non-osteoporotic women: the OFELY study

Summary

The use of areal bone mineral density (aBMD) for fracture prediction may be enhanced by considering bone microarchitectural deterioration. Trabecular bone score (TBS) helped in redefining a significant subset of non-osteoporotic women as a higher risk group.

Introduction

TBS is an index of bone microarchitecture. Our goal was to assess the ability of TBS to predict incident fracture.

Methods

TBS was assessed in 560 postmenopausal women from the Os des Femmes de Lyon cohort, who had a lumbar spine (LS) DXA scan (QDR 4500A, Hologic) between years 2000 and 2001. During a mean follow-up of 7.8?±?1.3 years, 94 women sustained 112 fragility fractures.

Results

At the time of baseline DXA scan, women with incident fracture were significantly older (70?±?9 vs. 65?±?8 years) and had a lower LS_aBMD and LS_TBS (both ?0.4SD, p?<?0.001) than women without fracture. The magnitude of fracture prediction was similar for LS_aBMD and LS_TBS (odds ratio [95 % confidence interval]?=?1.4 [1.2;1.7] and 1.6 [1.2;2.0]). After adjustment for age and prevalent fracture, LS_TBS remained predictive of an increased risk of fracture. Yet, its addition to age, prevalent fracture, and LS_aBMD did not reach the level of significance to improve the fracture prediction. When using the WHO classification, 39 % of fractures occurred in osteoporotic women, 46 % in osteopenic women, and 15 % in women with T-score?>??1. Thirty-seven percent of fractures occurred in the lowest quartile of LS_TBS, regardless of BMD. Moreover, 35 % of fractures that occurred in osteopenic women were classified below this LS_TBS threshold.

Conclusion

In conclusion, LS_aBMD and LS_TBS predicted fractures equally well. In our cohort, the addition of LS_TBS to age and LS_aBMD added only limited information on fracture risk prediction. However, using the lowest quartile of LS_TBS helped in redefining a significant subset of non-osteoporotic women as a higher risk group which is important for patient management.