Empirically based composite fracture prediction model from the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW).

Academic Article

Abstract

  • CONTEXT: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired. OBJECTIVE: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles. DESIGN: This was a prospective, observational cohort study. SETTING: The study was conducted at primary care practices in 10 countries. PATIENTS: Women aged 55 years or older participated in the study. INTERVENTION: Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures. MAIN OUTCOME MEASURE: The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age. RESULTS: Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase. CONCLUSIONS: After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model.
  • Authors

    Keywords

  • Age Factors, Aged, Aged, 80 and over, Cohort Studies, Female, Fractures, Bone, Humans, Longitudinal Studies, Middle Aged, Models, Statistical, Osteoporosis, Postmenopausal, Prognosis, Risk Factors
  • Digital Object Identifier (doi)

    Author List

  • FitzGerald G; Compston JE; Chapurlat RD; Pfeilschifter J; Cooper C; Hosmer DW; Adachi JD; Anderson FA; Díez-Pérez A; Greenspan SL
  • Start Page

  • 817
  • End Page

  • 826
  • Volume

  • 99
  • Issue

  • 3