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

Dennison, E.M., Compston, J.E., Flahive, J., Siris, E.S., Gehlbach, S.H., Adachi, J.D., Boonen, Steven, Chapurlat, R., Diez-Perez, A., Anderson, F.A., Hooven, F.H., Lacroix, A.Z., Lindsey, R., Netelenbos, J.C., Pfeilschifter, J., Rossini, M., Roux, C., Saag, K., Sambrook, P., Silverman, S., Watts, N.B., Greenspan, S.L., Premaor, M. and Cooper, C. (2012) Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW). Bone, 50 (6), 1288-1293. (doi:10.1016/j.bone.2012.02.639). (PMID:22426498)

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

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Contributors

Author: E.M. Dennison

Author: C. Cooper

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