Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW).

Academic Article

Abstract

  • INTRODUCTION: Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. MATERIALS AND METHODS: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. RESULTS: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. CONCLUSION: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.
  • Authors

    Published In

  • BONE  Journal
  • Keywords

  • Aged, Aged, 80 and over, Algorithms, Cohort Studies, Comorbidity, Female, Humans, Longitudinal Studies, Middle Aged, Osteoporosis, Postmenopausal, Osteoporotic Fractures, Parkinson Disease, Proportional Hazards Models, Risk Factors
  • Digital Object Identifier (doi)

    Author List

  • Dennison EM; Compston JE; Flahive J; Siris ES; Gehlbach SH; Adachi JD; Boonen S; Chapurlat R; Díez-Pérez A; Anderson FA
  • Start Page

  • 1288
  • End Page

  • 1293
  • Volume

  • 50
  • Issue

  • 6