Multidimensional prognostic index and the risk of fractures: an 8-year longitudinal cohort study in the Osteoarthritis Initiative

Abstract

Summary In this longitudinal study, with a follow-up of 8 years, multidimensional prognostic index (MPI), a product of the comprehensive geriatric assessment, significantly predicted the onset of fractures in older people affected by knee osteoarthritis. Purpose Frailty may be associated with higher fracture risk, but limited research has been carried out using a multidimensional approach to frailty assessment and diagnosis. The present research aimed to investigate whether the MPI, based on comprehensive geriatric assessment (CGA), is associated with the risk of fractures in the Osteoarthritis Initiative (OAI) study. Methods Community-dwellers affected by knee OA or at high risk for this condition were followed-up for 8 years. A standardized CGA including information on functional, nutritional, mood, comorbidity, medication, quality of life, and co-habitation status was used to calculate the MPI. Fractures were diagnosed using self-reported information. Cox’s regression analysis was carried out and results are reported as hazard ratios (HRs), with their 95% confidence intervals (CIs), adjusted for potential confounders. Results The sample consisted of 4024 individuals (mean age 61.0 years, females = 59.0%). People with incident fractures had a significant higher MPI baseline value than those without (0.42 ± 0.18 vs. 0.40 ± 0.17). After adjusting for several potential confounders, people with an MPI over 0.66 (HR = 1.49; 95%CI: 1.11–2.00) experienced a higher risk of fractures. An increase in 0.10 point in MPI score corresponded to an increase in fracture risk of 4% (HR = 1.04; 95%CI: 1.008–1.07). Higher MPI values were also associated with a higher risk of non-vertebral clinical fractures. Conclusion Higher MPI values at baseline were associated with an increased risk of fractures, reinforcing the importance of CGA in predicting fractures in older people affected by knee OA.

The role of comprehensive geriatric assessment in older patients affected by knee osteoarthritis: a systematic review

“…As reported in Figure 1, among 295 articles initially included, ten full texts were retrieved and three were included. [15][16][17] All the three studies were performed in the context of the osteoarthritis initiative (OAI) (https:// www.niams.nih.gov/grants-funding/fundedresearch/osteoarthritis-initiative), a large epidemiological study including 4796 people with knee OA or at high risk for this condition, with a follow-up up to eight years.…”

Osteoarthritis and Frailty: Associations, Relevance, and Counter Solutions

“…At the same time, other data imply more attention to offset frailty at all ages is not only desirable, but essential in consideration of its impact on older adults. This is because frailty is not only found to significantly predict a high risk for fracturing one or more bones [26,31], but severe insomnia symptoms [35], and increased mortality rates in both subjects with and without osteoarthritis, but especially those with osteoarthritis [47,26,28,31]. Factors to consider here other than older age are being female, obese, having cardiovascular disease, osteoarthritis, a loss of vision, having lower education levels, low levels of self-efficacy and physical performance, plus cognitive impairments, poor health perceptions, hypovitaminosis D, hyperuricemia, and polypharmacy [53,57].…”