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Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women

Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women
Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women
The FRAX(tr) algorithm uses clinical risk factors (CRF) and bone mineral density (BMD) to predict fracture risk but does not include falls history in the calculation. Using results from the Hertfordshire Cohort Study, we examined the relative contributions of CRFs, BMD and falls history to fracture prediction. We studied 2299 participants at a baseline clinic that included completion of a health questionnaire and anthropometric data. A mean of 5.5years later (range 2.9-8.8years) subjects completed a postal questionnaire detailing fall and fracture history. In a subset of 368 men and 407 women, bone densitometry was performed using a Hologic QDR 4500 instrument. There was a significantly increased risk of fracture in men and women with a previous fracture. A one standard deviation drop in femoral neck BMD was associated with a hazards ratio (HR) of incident fracture (adjusted for CRFs) of 1.92 (1.04-3.54) and 1.77 (1.16-2.71) in men and women respectively. A history of any fall since the age of 45years resulted in an unadjusted HR of fracture of 7.31 (3.78-14.14) and 8.56 (4.85-15.13) in men and women respectively. In a ROC curve analysis, the predictive capacity progressively increased as BMD and previous falls were added into an initial model using CRFs alone. Falls history is a further independent risk factor for fracture. Falls risk should be taken into consideration when assessing whether or not to commence medication for osteoporosis and should also alert the physician to the opportunity to target falls risk directly.
epidemiology, osteoporosis, bmd, fracture, fall, frax
8756-3282
541-547
Edwards, M.H.
b81ff294-1d16-4a1b-af14-9374c5989d4c
Jameson, K.
d5fb142d-06af-456e-9016-17497f94e9f2
Denison, H.J.
dbe5f26d-6323-4477-9519-c826869b7810
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Sayer, A. Aihie
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb
Dennison, E.M.
ee647287-edb4-4392-8361-e59fd505b1d1
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Edwards, M.H.
b81ff294-1d16-4a1b-af14-9374c5989d4c
Jameson, K.
d5fb142d-06af-456e-9016-17497f94e9f2
Denison, H.J.
dbe5f26d-6323-4477-9519-c826869b7810
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Sayer, A. Aihie
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb
Dennison, E.M.
ee647287-edb4-4392-8361-e59fd505b1d1
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6

Edwards, M.H., Jameson, K., Denison, H.J., Harvey, N.C., Sayer, A. Aihie, Dennison, E.M. and Cooper, C. (2013) Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women. Bone, 52 (2), 541-547. (doi:10.1016/j.bone.2012.11.006). (PMID:23159464)

Record type: Article

Abstract

The FRAX(tr) algorithm uses clinical risk factors (CRF) and bone mineral density (BMD) to predict fracture risk but does not include falls history in the calculation. Using results from the Hertfordshire Cohort Study, we examined the relative contributions of CRFs, BMD and falls history to fracture prediction. We studied 2299 participants at a baseline clinic that included completion of a health questionnaire and anthropometric data. A mean of 5.5years later (range 2.9-8.8years) subjects completed a postal questionnaire detailing fall and fracture history. In a subset of 368 men and 407 women, bone densitometry was performed using a Hologic QDR 4500 instrument. There was a significantly increased risk of fracture in men and women with a previous fracture. A one standard deviation drop in femoral neck BMD was associated with a hazards ratio (HR) of incident fracture (adjusted for CRFs) of 1.92 (1.04-3.54) and 1.77 (1.16-2.71) in men and women respectively. A history of any fall since the age of 45years resulted in an unadjusted HR of fracture of 7.31 (3.78-14.14) and 8.56 (4.85-15.13) in men and women respectively. In a ROC curve analysis, the predictive capacity progressively increased as BMD and previous falls were added into an initial model using CRFs alone. Falls history is a further independent risk factor for fracture. Falls risk should be taken into consideration when assessing whether or not to commence medication for osteoporosis and should also alert the physician to the opportunity to target falls risk directly.

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Published date: February 2013
Keywords: epidemiology, osteoporosis, bmd, fracture, fall, frax
Organisations: Faculty of Medicine

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Local EPrints ID: 349231
URI: http://eprints.soton.ac.uk/id/eprint/349231
ISSN: 8756-3282
PURE UUID: 6ce55858-a5bc-44e6-a50a-615ef0589509
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for E.M. Dennison: ORCID iD orcid.org/0000-0002-3048-4961
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 27 Feb 2013 09:40
Last modified: 18 Feb 2021 17:02

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Contributors

Author: M.H. Edwards
Author: K. Jameson
Author: H.J. Denison
Author: N.C. Harvey ORCID iD
Author: A. Aihie Sayer
Author: E.M. Dennison ORCID iD
Author: C. Cooper ORCID iD

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