Impact of Competing Risk of Mortality on Association of Weight Loss With Risk of Central Body Fractures in Older Men: A Prospective Cohort Study |
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| Authors: | Kristine E Ensrud Stephanie L Harrison Jane A Cauley Lisa Langsetmo John T Schousboe Deborah M Kado Margaret L Gourlay Jennifer G Lyons Lisa Fredman Nicolas Napoli Carolyn J Crandall Cora E Lewis Eric S Orwoll Marcia L Stefanick Peggy M Cawthon for the Osteoporotic Fractures in Men Research Group |
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| Institution: | 1. Department of Medicine, University of Minnesota, Minneapolis, MN, USA;2. Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA;3. Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA;4. California Pacific Medical Center Research Institute, San Francisco, CA, USA;5. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA;6. HealthPartners Institute, Bloomington, MN, USA;7. Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA;8. Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA;9. Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA;10. Department of Epidemiology, Boston University, Boston, MA, USA;11. Division of Endocrinology and Diabetes, Università Campus Bio‐Medico di Roma, Rome, Italy;12. Deparment of Medicine, University of California, Los Angeles, Los Angeles, CA, USA;13. Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA;14. Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA;15. Department of Medicine, Stanford University, Stanford, CA, USA |
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| Abstract: | To determine the association of weight loss with risk of clinical fractures at the hip, spine, and pelvis (central body fractures CBFs]) in older men with and without accounting for the competing risk of mortality, we used data from 4523 men (mean age 77.5 years). Weight change between baseline and follow‐up (mean 4.5 years between examinations) was categorized as moderate loss (loss ≥10%), mild loss (loss 5% to <10%), stable (<5% change) or gain (gain ≥5%). Participants were contacted every 4 months after the follow‐up examination to ascertain vital status (deaths verified by death certificates) and ask about fractures (confirmed by radiographic reports). Absolute probability of CBF by weight change category was estimated using traditional Kaplan‐Meier method and cumulative incidence function accounting for competing mortality risk. Risk of CBF by weight change category was determined using conventional Cox proportional hazards regression and subdistribution hazards models with death as a competing risk. During an average of 8 years, 337 men (7.5%) experienced CBF and 1569 (34.7%) died before experiencing this outcome. Among men with moderate weight loss, CBF probability was 6.8% at 5 years and 16.9% at 10 years using Kaplan‐Meier versus 5.7% at 5 years and 10.2% at 10 years using a competing risk approach. Men with moderate weight loss compared with those with stable weight had a 1.6‐fold higher adjusted risk of CBF (HR 1.59; 95% CI, 1.06 to 2.38) using Cox models that was substantially attenuated in models accounting for competing mortality risk and no longer significant (subdistribution HR 1.16; 95% CI, 0.77 to 1.75). Results were similar in analyses substituting hip fracture for CBF. Older men with weight loss who survive are at increased risk of CBF, including hip fracture. However, ignoring the competing mortality risk among men with weight loss substantially overestimates their long‐term fracture probability and relative fracture risk. © 2016 American Society for Bone and Mineral Research. |
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| Keywords: | CENTRAL BODY FRACTURES WEIGHT CHANGE MORTALITY OLDER MEN |
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