Effectiveness of Bone Density Measurement for Predicting Osteoporotic Fractures in Clinical Practice

Leslie, William D.; Tsang, James F.; Caetano, Patrícia; Lix, Lisa M.

doi:10.1210/jc.2006-1415

Cited by 121 publications

(84 citation statements)

References 26 publications

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“…(22) For purposes of the FRAX calculation, prior fragility fracture was taken to be a major osteoporotic fracture (hip, clinical vertebral, forearm, and humerus fracture) before BMD testing that was not associated with severe trauma as previously described. (23) A diagnosis of rheumatoid arthritis was taken from physician office visits or hospitalizations with a compatible ICD-9-CM/ICD-10-CA code in a 3-year period before BMD testing. Proxies were used for smoking [chronic obstructive pulmonary disease (COPD) diagnosis] and high alcohol intake (alcohol or substance abuse diagnosis) over the same time frame.…”

Section: Bone Density Measurementsmentioning

confidence: 99%

“…Briefly, longitudinal health service records were assessed for the presence of hip, clinical vertebral, forearm, and humerus fracture codes (collectively designated as ''major osteoporotic'') after BMD testing that were not associated with trauma codes. (23) Incident fractures were defined as fractures that occurred after the index BMD measurement and generated two or more site-specific fracture codes in any diagnosis field (hospitalization or physician visit). We required that hip fractures and forearm fractures be accompanied by a site-specific fracture reduction, fixation, or casting code as this enhances the diagnostic and temporal specificity for an acute fracture event.…”

Section: Bone Density Measurementsmentioning

confidence: 99%

See 1 more Smart Citation

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Leslie

Lix

Johansson

et al. 2012

Journal of Bone and Mineral Research

115

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Ten-year fracture risk assessment with the fracture risk assessment system (FRAX) is increasingly used to guide treatment decisions. Osteoporosis pharmacotherapy reduces fracture risk, but the effect is greater than can be explained from the increase in bone mineral density (BMD). Whether this invalidates fracture predictions with FRAX is uncertain. A total of 35,764 women (age !50 years) and baseline BMD testing (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) had FRAX probabilities retroactively calculated. A provincial pharmacy database was used to identify osteoporosis medication use. Women were categorized as untreated, current high adherence users [medication possession ratio (MPR) !0.80 in the year after BMD testing], current low adherence users (MPR <0.80), and past users. Fractures outcomes to 10 years were established form a population-based health data repository. FRAX and femoral neck BMD alone stratified major osteoporotic and hip fracture risk within untreated and each treated subgroup (all p-values <0.001) with similar area under the receiver operating characteristic curve. In untreated and each treated subgroup, a stepwise gradient in observed 10-year major osteoporotic and hip fracture incidence was found as a function of the predicted probability tertile (all p-values <0.001 for linear trend). Concordance (calibration) plots for major osteoporotic fractures and hip fractures showed good agreement between the predicted and observed 10-year fracture incidence in untreated women and each treated subgroup. Only in the highest risk tertile of women highly adherent to at least 5 years of bisphosphonate use was observed hip fracture risk significantly less than predicted, though major osteoporotic fracture risk was similar to predicted. In summary, this work suggests that the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis. Although FRAX should not be used to assess the reduction in fracture risk in individuals on treatment, it may still have value for guiding the need for continued treatment or treatment withdrawal. ß

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Section: Bone Density Measurementsmentioning

confidence: 99%

Section: Bone Density Measurementsmentioning

confidence: 99%

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Leslie

Lix

Johansson

et al. 2012

Journal of Bone and Mineral Research

115

View full text Add to dashboard Cite

show abstract

“…Prolonged glucocorticoid use was defined as over 90 days dispensed in the year prior to DXA testing at a mean prednisoneequivalent dose of 7.5 mg per day or greater. Longitudinal health service records were assessed for the presence of hip, clinical vertebral, forearm, and humerus fracture codes (collectively designated as "osteoporotic") before and after BMD testing that were not associated with trauma codes [26]. We required that hip fractures and forearm fractures be accompanied by a site-specific fracture reduction, fixation, or casting code which enhances the diagnostic and temporal specificity for an acute fracture.…”

Section: Manitoba Cohortmentioning

confidence: 99%

Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts

et al. 2010

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“…Using these fracture definitions, we have shown previously that BMD measurements predict fractures in our clinical cohort, as well as has been reported in large meta-analyses. (24) Clinical endpoints…”

Section: Study Design and Populationmentioning

confidence: 99%

Time since prior fracture is a risk modifier for 10-year osteoporotic fractures

Giangregorio

Leslie

2010

Journal of Bone and Mineral Research

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The objective of this study was to assess the importance of time since prior fracture as a risk factor for future osteoporotic fractures and how it affects 10-year fracture rates. We identified 39,991 women 45 years of age or older undergoing baseline bone mineral density (BMD) testing (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)) from a regional database that contains dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada. Health service records were used to identify nontrauma ICD-9-CM fracture codes preceding DXA, grouped as ''major'' fractures (n ¼ 5178; hip, spine, forearm, and humerus) or ''minor'' fractures (n ¼ 3479; ribs, sternum, pelvis, trunk, clavicle, scapula, patella, tibia/fibula, and ankle). Time since prior fracture was coded in years as less than 1, 1 to 5, 5 to 10, and more than 10. Incident fractures (ie, hip, spine, forearm, and humerus) after BMD testing were identified (mean follow-up 4.2 years, maximum 10 years) and studied in Cox proportionalhazards models adjusted for age, BMD T-score, and other covariates. After BMD testing, n ¼ 1749 (4.4%) women experienced an incident fracture. Prior major fracture was a strong risk factor for incident fracture, greatest risk in the first year [hazard ratio (HR) 1.90, 95% confidence interval (CI) 1.60-2.25], declining by more than 10 years (HR 1.62, 95% CI 1.25-2.10). Prior minor fracture was a weaker risk factor, greatest in the first year (HR 1.45, 95% CI 1.13-1.87) and no longer significant by 1 to 5 years. Major and minor fractures both showed a time-dependent decline in importance as risk factors. In conclusion, time since prior fracture modifies future fracture risk, but prior fractures of the hip, spine, forearm, and humerus remain strong risk factors even 10 years later. Fracture risk assessment should emphasize the importance of prior fractures at these sites. ß

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Effectiveness of Bone Density Measurement for Predicting Osteoporotic Fractures in Clinical Practice

Abstract: Bone density measurements are effective for predicting fractures in clinical practice. However, hip measurements were superior to the spine in overall osteoporotic fracture prediction.

Cited by 121 publications

References 26 publications

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts

Time since prior fracture is a risk modifier for 10-year osteoporotic fractures

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