Fracture prediction from self-reported falls in routine clinical practice: a registry-based cohort study

Leslie, William D.; Morin, Suzanne N; Lix, Lisa M.; Martineau, Patrick; Bryanton, Mark; McCloskey, Eugène; Johansson, Helena; Harvey, Nicholas C; Kanis, John А.

doi:10.1007/s00198-019-05106-3

Cited by 25 publications

(15 citation statements)

References 29 publications

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“…Falls is not currently an input variable to FRAX but may be one of the mediating factors contributing to early refracture risk since falls often occur in succession and increase fracture risk independently from FRAX. ( 40 ) The decrease in muscle strength and physical performance found during the first months after fracture may also be important. ( 41 ) Finally, the Manitoba BMD Registry population is almost exclusively (>97%) of White ethnicity, and we cannot be certain that our findings will apply to other populations or to men.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Fracture Recency on Observed 10-Year Fracture Probability: A Registry-Based Cohort Study

Leslie

Morin

Lix

et al. 2020

Journal of Bone and Mineral Research

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FRAX estimates 10‐year fracture major osteoporotic fracture (MOF) and hip fracture probability from multiple risk factors. FRAX does not consider prior fracture site or time since fracture. Fracture risk is greater in the initial 2‐year post‐fracture period (imminent risk), implying that FRAX may underestimate risk in this setting. We used the population‐based Manitoba Bone Mineral Density (BMD) Program registry to examine the effect of fracture recency and site on incident fracture risk predictions using FRAX. We identified women aged 40 years or older with baseline BMD and FRAX scores. Observed fracture outcomes to 10 years were compared with predicted 10‐year fracture probability stratified by prior fracture status: none, recent (<2 years [median 0.3 years]), and remote (≥2 years [median 10.6 years]). For women with recent fractures, we also examined proposed multipliers to adjust FRAX for the effect of fracture recency and site. The cohort comprised 33,465 women aged 40 to 64 years (1897 recent fracture, 2120 remote fracture) and 33,806 women aged ≥65 years (2365 fracture, 4135 remote fracture). Observed fracture probability was consistent with predicted probability in most analyses. In women aged 40 to 64 years, there was a significant effect of recent vertebral and humerus fracture on MOF (observed to predicted 1.61 and 1.48, respectively), but these effects were still lower than the proposed multipliers (2.32 and 1.67, respectively). No significant effect of fracture recency was found after hip or forearm fracture in either age group. Our findings contribute to accumulating evidence of the importance of recent fracture. The effect of fracture recency was not consistent across fracture sites and with a lower magnitude than previously reported. Further quantification of effect size and specificity in additional independent cohorts is warranted to validate and refine recent‐fracture multipliers in fracture risk assessment. © 2022 American Society for Bone and Mineral Research (ASBMR).

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Section: Discussionmentioning

confidence: 99%

The Effect of Fracture Recency on Observed 10-Year Fracture Probability: A Registry-Based Cohort Study

Leslie

Morin

Lix

et al. 2020

Journal of Bone and Mineral Research

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“…To address some of these limitations, relatively simple arithmetic procedures have been proposed which can be applied to the conventional FRAX estimates of probabilities of hip fracture and a major fracture to adjust the probability assessment with knowledge of: high, moderate, and low exposure to glucocorticoids [74]; concurrent data on lumbar spine BMD [75, 76]; information on trabecular bone score (TBS) [77][78][79]; hip axis length [80]; falls history [81,82]; immigration status [83]; type 2 diabetes [47, 84]; chronic kidney disease [85]; recency of vertebral fracture [37,86].…”

Section: Frax For Connoisseursmentioning

confidence: 99%

A decade of FRAX: how has it changed the management of osteoporosis?

et al. 2020

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The fracture risk assessment tool, FRAX ® , was released in 2008 and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture (hip, clinical spine, distal forearm, and proximal humerus). Since its release, 71 models have been made available for 66 countries covering more than 80% of the world population. The website receives approximately 3 million visits annually. Following independent validation, FRAX has been incorporated into more than 80 guidelines worldwide. The application of FRAX in assessment guidelines has been heterogeneous with the adoption of several different approaches in setting intervention thresholds. Whereas most guidelines adopt a case-finding strategy, the case for FRAX-based community screening in the elderly is increasing. The relationship between FRAX and efficacy of intervention has been explored and is expected to influence treatment guidelines in the future.

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“…These included previous osteoporosis treatment (identified as 6 months or greater dispensed quantity of an osteoporosis medication or systemic estrogen product in the prior year from the province-wide retail pharmacy system) (20); a comorbidity index (number of ambulatory diagnostic groups from the Johns Hopkins Adjusted Clinical Group ® [ACG ® ] Case-Mix System, version 11) (21); diagnosed diabetes from hospital and medical claims (22)(23)(24); area of residence (urban versus rural) and income (lower versus upper) defined from neighborhood level data (25,26); DXA-derived geometric measures of femur neck area (cm 2 ); total hip area; (cm 2 ) and hip axis length (HAL, mm) (27)(28)(29)(30); lumbar spine trabecular bone score (TBS, unitless) (31,32); and DXA-estimated total body lean mass and fat mass divided by height squared to provide a size-adjusted index (kg/m 2 ) (33). In the subset of those undergoing assessment since September 1, 2012 we also collected number of self-reported falls in the preceding year as previously described (34); the falls data are reported cross-sectionally since the numbers and follow up were insufficient for assessment of between-ethnicity differences in fracture outcomes.…”

Section: Additional Covariatesmentioning

confidence: 99%

Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study

et al. 2020

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Purpose-FRAX ® is calibrated using population-specific fracture and mortality data. The need for FRAX to accommodate ethnic diversity within a country is uncertain. We addressed this question using the population-based Manitoba Bone Mineral Density (BMD) Program registry and self-reported ethnicity.Methods-The study population was women age 40 years or older with baseline FRAX assessments (Canadian and other ethnic calculators), fracture outcomes and self-reported ethnicity (White N=68,907 [referent], Asian N=1,910, Black N=356). Adjusted hazard ratios (HR) with 95 % confidence intervals (CI) for time to MOF and hip fracture were estimated. We examined candidate variables from DXA that might contribute to ethnic differences including skeletal size, hip axis length (HAL), trabecular bone score (TBS), and estimated body composition.

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Fracture prediction from self-reported falls in routine clinical practice: a registry-based cohort study

Cited by 25 publications

References 29 publications

The Effect of Fracture Recency on Observed 10-Year Fracture Probability: A Registry-Based Cohort Study

The Effect of Fracture Recency on Observed 10-Year Fracture Probability: A Registry-Based Cohort Study

A decade of FRAX: how has it changed the management of osteoporosis?

Fracture prediction from FRAX for Canadian ethnic groups: a registry-based cohort study

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