Correlation of hip fracture with other fracture types: Toward a rational composite hip fracture endpoint |
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| Institution: | 1. Duke University Center for the Study of Aging and Human Development, Durham, NC, United States;2. Durham VA Geriatric Research Education and Clinical Center, Durham, NC, United States;3. Durham VA Health Services Research and Development Center, Durham, NC, United States;4. University of Utah, Salt Lake City, UT, United States;5. McGuire VA Medical Center, Richmond, VA, United States;6. Duke University Department of Medicine, Durham, NC, United States;1. Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine III, Technische Universität Medical Center and Center for Regenerative Therapies Dresden, D-01307 Dresden, Germany;2. Departments of Orthopaedic Surgery, Physiology and Phamacology, Center for Diabetes and Endocrine Research, University of Toledo Health Science Campus, Toledo, OH 43560, USA;3. Bone Research Program, ANZAC Research Institute, and Department of Endcorinology, Concord Hospital, The University Sydney, Sydney, Australia;1. Dept. of Orthopaedic Surgery, Center for Diabetes and Endocrine Research, University of Toledo Health Sciences Campus, Toledo, OH 43614, United States;2. Dept. of Physiology and Pharmacology, Center for Diabetes and Endocrine Research, University of Toledo Health Sciences Campus, Toledo, OH 43614, United States;3. Tufts University School of Medicine, and Maine Medical Center Research Institute, Scarborough, ME 04074, United States;1. Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China;2. Department of Pharmacology, Institute of Acute Abdominal Diseases, Tianjin Nankai Hospital, Tianjin 300100, China;3. Department of Biomedical Engineering, Indiana University–Purdue University Indianapolis, IN 46202, USA;1. Research Promotion, Ono Pharmaceutical Co., Ltd., Shimamoto, Osaka, Japan;2. Translational Medicine Center, Ono Pharmaceutical Co., Ltd., Shimamoto, Osaka, Japan;1. Postgraduation Program in Medicine, Medical Science, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil;2. Internal Medicine Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil |
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| Abstract: | PurposeWith ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction.MethodsCohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n = 5,036,536) aged 50–99 years receiving VA primary care between 1999 and 2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics were used to describe the correlation between each fracture type and hip fracture within individuals, without regard to the timing of the events.Results595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, the rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, p < 0.0001), femur (0.15, p < 0.0001), and shoulder (0.11, p < 0.0001).ConclusionsPelvic, acetabular, femur, and shoulder fractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider the use of a composite endpoint to better estimate hip fracture risk. |
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