Prediction of osteoporotic fractures by postural instability and bone density.

Nguyen, Tuan V.; Sambrook, Philip N.; Pj, Kelly; Jones, Graeme; Lord, Stephen R.; Freund, Judith; Eisman, John A.

doi:10.1136/bmj.307.6912.1111

Cited by 536 publications

(356 citation statements)

References 32 publications

Supporting

Mentioning

331

Contrasting

Unclassified

Order By: Relevance

“…BMD measurements have been shown to predict hip fracture probability in the range 17-43% in a 6-year period [7]. Although the prediction of fractures by simple risk indicators may be not as effective as by BMD measurements, other risk factors, not related to bone, have been shown to supply additional information to BMD in the prediction of hip fractures [4,15,16]. Other easily obtainable risk indicators, not included in this study (e.g.…”

Section: Discussionmentioning

confidence: 94%

Different risk profiles for hip fractures and distal forearm fractures: A prospective study

et al. 1996

View full text Add to dashboard Cite

Abstract. In a prospective cohort of elderly persons, aged 70 years and over, we examined risk indicators for which data could be easily obtained, to construct risk profiles for hip fractures and distal forearm fractures. Participants lived independently, in apartment houses for the elderly or in homes for the elderly. At baseline, information was obtained in 2578 subjects on age, gender, residence, mobility and the frequency of going outdoors. Mobility was measured using a walking score ranging from 1 (not able to walk independently) to 3 (able to walk independently for a fair distance). During the study period (median duration 3.5 years, maximum 4 years) 106 participants sustained a hip fracture and 60 participants suffered a distal forearm fracture. Women compared with men, adjusted for age, had a higher risk of hip fracture (adjusted relative risk (RR) = 2.4, 95% confidence interval (CI) 1.3-4.3) and distal forearm fracture (RR = 3.7, 95% CI 1.5-9.2). Age, adjusted for gender, was related to hip fractures only: the relative risk of fracture for those in the highest age category (>85 years) was 9.5 (95% CI 4.3-21.2) compared with those in the lowest age category (70-75 years). Moderately impaired walking ability compared with normal walking ability, adjusted for age and gender, was associated with a higher risk of hip fracture (RR = 1.8, 95% CI 1.2-2.7) but with a lower risk of distal forearm fracture (RR = 0.4, 95% CI 0.2-0.8). The outdoor score, adjusted for age and gender, was associated with distal forearm fractures only: going outdoors less than once a week, compared with three times or more, was associated with a lower risk of fractures (RR = 0.3, 95%Correspondence and offprint requests to: W. C. Graafmans, Institute for Research in Extramural Medicine (EMGO Institue), Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.CI 0.1-0.9). In those living in homes for the elderly the risk of hip fracture was higher compared with those living independently (RR = 2.4, 95% CI 1.4-4.2), adjusted for age and gender. Risk profiles were constructed using stepwise Cox's proportional-hazards regression. The risk profile predicted probabilites of sustaining a hip fracture in a 4-year period ranging from 0.4% to 25.9%, and of distal forearm fractures ranging from 0.2% to 4.5%, depending on the subject's characteristics as defined by the risk indicators. We conclude that easily obtainable risk indicators can be used in the prediction of fractures and can discriminate among fracture types.

show abstract

Section: Discussionmentioning

confidence: 94%

Different risk profiles for hip fractures and distal forearm fractures: A prospective study

et al. 1996

View full text Add to dashboard Cite

show abstract

“…(20)(21)(22)(23) Briefly, in 1989, all men and women aged 60 years or above (as of 1989) living in Dubbo, a city of approximately 32,000 people 400 km northwest of Sydney (Australia), were invited to participate in an epidemiologic study. At that time, the population consisted of 1581 men and 2095 women aged 60 years or older, of whom 98.6% were white and 1.4% were indigenous aboriginal.…”

Section: Study Setting and Participantsmentioning

confidence: 99%

“…Fractures occurring during the study period were identified for residents of the Dubbo local government area through radiologists' reports from the two centers providing X-ray services, as described previously. (20,21) Fractures were included only if the report of fracture was definite and, on interview, had occurred with low trauma (eg, fall from standing height or less). Fractures clearly owing to major trauma (eg, motor vehicle accidents), those owing to underlying diseases (eg, cancer or bone-related diseases), or those of digit, skull, or cervical spine were excluded from the analysis.…”

Section: Ascertainment Of Fracturementioning

confidence: 99%

Genetic profiling and individualized prognosis of fracture

Tran

Nguyen

et al. 2010

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Fragility fracture is a serious public health problem in the world. The risk of fracture is determined by genetic and nongenetic clinical risk factors. This study sought to quantify the contribution of genetic profiling to fracture prognosis. The study was built on the ongoing Dubbo Osteoporosis Epidemiology Study, in which fracture and risk factors of 858 men and 1358 women had been monitored continuously from 1989 and 2008. Fragility fracture was ascertained by radiologic reports. Bone mineral density at the femoral neck was measured by dual-energy X-ray absorptiometry (DXA). Fifty independent genes with allele frequencies ranging from 0.01 to 0.60 and relative risks (RRs) ranging from 1.01 to 3.0 were simulated. Three predictive models were fitted to the data in which fracture was a function of (1) clinical risk factors only, (2) genes only, and (3) clinical risk factors and 50 genes. The area under the curve (AUC) for model 1 was 0.77, which was lower than that of model II (AUC ¼ 0.82). Adding genes into the clinical risk factors model (model 3) increased the AUC to 0.88 and improved the accuracy of fracture classification by 45%, with most (41%) improvement in specificity. In the presence of clinical risk factors, the number of genes required to achieve an AUC of 0.85 was around 25. These results suggest that genetic profiling could enhance the predictive accuracy of fracture prognosis and help to identify high-risk individuals for appropriate management of osteoporosis or intervention. ß

show abstract

“…(4,(8)(9)(10) Arguments to support the latter focus on reports that men fracture at a higher level of BMD than women. (11)(12)(13) These two sets of observations are often presented as in conflict. (14) A recent review by Khosla and colleagues (15) concluded that the most appropriate definition for osteoporosis in men, in the absence of fractures, was a major unresolved issue and should be the focus of future research.…”

Section: Introductionmentioning

confidence: 99%

Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Langsetmo

Leslie

Zhou

et al. 2010

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

Although low bone mineral density (BMD) predicts fractures, there are postulated sex differences in the fracture ''threshold.'' Some studies demonstrate a higher mean BMD for men with fractures than for women, whereas others note similar absolute risk at the same level of BMD. Our objective was to test the preceding observations in the population-based Canadian Multicentre Osteoporosis Study (CaMOS). We included participants 50þ years of age at baseline. Mean BMD in men was higher than in women among both fracture cases and noncases. Three methods of BMD normalization were compared in age-adjusted Cox proportional hazards models. In a model using the same reference population mean and standard deviation (SD), there were strong effects of age and total-hip BMD for prediction of fractures but no significant effect of sex [hazard ratio (HR) ¼ 0.97, 95% confidence interval (CI) 0.78-1.20] for men versus women. In a model using sex-specific reference means but a common SD, an apparent sex difference emerged (HR ¼ 0.66, 95% CI 0.54-0.81) for men versus women. The sex term in the second model counterbalanced the higher risk introduced by the lower normalized BMD in men. A third model using sex-specific reference means and SDs gave nearly identical results. Parallel results for the three methods of normalization were seen when adjusting for clinical risk factors, excluding antiresorptive users and considering death as a competing risk. We conclude that no adjustment for sex is necessary when using common reference data for both men and women, whereas using sex-specific reference data requires a substantial secondary adjustment for sex. ß

show abstract

Prediction of osteoporotic fractures by postural instability and bone density.

Cited by 536 publications

References 32 publications

Different risk profiles for hip fractures and distal forearm fractures: A prospective study

Different risk profiles for hip fractures and distal forearm fractures: A prospective study

Genetic profiling and individualized prognosis of fracture

Using the same bone density reference database for men and women provides a simpler estimation of fracture risk

Contact Info

Product

Resources

About