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Measures of physical performance and muscle strength as predictors of fracture risk independent of FRAX, falls and BMD: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) study

Measures of physical performance and muscle strength as predictors of fracture risk independent of FRAX, falls and BMD: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) study
Measures of physical performance and muscle strength as predictors of fracture risk independent of FRAX, falls and BMD: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) study
Measures of muscle mass, strength and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX® probability. We investigated, in the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, USA), whether measures of physical performance/ appendicular lean mass by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck BMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for 5 chair stands, walking speed over 6m, grip strength, appendicular lean mass (ALM) adjusted for body size (ALM/height2), FRAX probability [major osteoporotic fracture (MOF) with or without femoral neck BMD, available in a subset of n = 7531], and incident MOF (hip, clinical vertebral, wrist or proximal humerus). Associations were adjusted for age, time since baseline, and are reported as hazard ratio (HR) for first incident fracture per SD increment in predictor, using meta‐analysis. 5660 men in USA (mean age 73.5 years); 2764 in Sweden (75.4 years); and 1987 in Hong Kong (72.4 years) were studied. Mean follow‐up time was 8.7‐10.9 years. Greater time for 5 chair stands was associated with greater risk of MOF [HR:1.26(95%CI:1.19,1.34)], whereas greater walking speed [HR:0.85(95%CI:0.79,0.90), grip strength [HR:0.77(95%CI:0.72,0.82)] and ALM/height2 [HR:0.85(95%CI:0.80,0.90)] were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but that between ALM/height2 and MOF was weakened [HR:0.92(95%CI:0.85,0.99]. Inclusion of femoral neck BMD markedly attenuated the association between ALM/height2 and MOF [HR:1.02(95%CI:0.96,1.10)]. Measures of physical performance predict incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height2 being substantially reduced by inclusion of BMD requires further study, these findings support the consideration of physical performance in fracture risk assessment.
0884-0431
Harvey, Nicholas
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Odén, Anders
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Orwoll, Eric
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Lapidus, Jodi
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Kwok, Timothy
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Karlsson, Magnus
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Rosengren, Bjorn E.
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Ribom, Eva
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Cooper, Cyrus
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Cawthon, Peggy M.
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Kanis, John A.
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Ohlsson, Claes
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Mellström, Dan
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Johansson, Helena
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McCloskey, Eugene
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Harvey, Nicholas
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Odén, Anders
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Orwoll, Eric
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Lapidus, Jodi
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Kwok, Timothy
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Karlsson, Magnus
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Rosengren, Bjorn E.
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Ribom, Eva
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Cooper, Cyrus
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Cawthon, Peggy M.
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Kanis, John A.
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Ohlsson, Claes
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Mellström, Dan
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Johansson, Helena
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McCloskey, Eugene
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Harvey, Nicholas, Odén, Anders, Orwoll, Eric, Lapidus, Jodi, Kwok, Timothy, Karlsson, Magnus, Rosengren, Bjorn E., Ribom, Eva, Cooper, Cyrus, Cawthon, Peggy M., Kanis, John A., Ohlsson, Claes, Mellström, Dan, Johansson, Helena and McCloskey, Eugene (2018) Measures of physical performance and muscle strength as predictors of fracture risk independent of FRAX, falls and BMD: A meta-analysis of the Osteoporotic Fractures in Men (MrOS) study. Journal of Bone and Mineral Research. (doi:10.1002/jbmr.3556).

Record type: Article

Abstract

Measures of muscle mass, strength and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX® probability. We investigated, in the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, USA), whether measures of physical performance/ appendicular lean mass by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck BMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for 5 chair stands, walking speed over 6m, grip strength, appendicular lean mass (ALM) adjusted for body size (ALM/height2), FRAX probability [major osteoporotic fracture (MOF) with or without femoral neck BMD, available in a subset of n = 7531], and incident MOF (hip, clinical vertebral, wrist or proximal humerus). Associations were adjusted for age, time since baseline, and are reported as hazard ratio (HR) for first incident fracture per SD increment in predictor, using meta‐analysis. 5660 men in USA (mean age 73.5 years); 2764 in Sweden (75.4 years); and 1987 in Hong Kong (72.4 years) were studied. Mean follow‐up time was 8.7‐10.9 years. Greater time for 5 chair stands was associated with greater risk of MOF [HR:1.26(95%CI:1.19,1.34)], whereas greater walking speed [HR:0.85(95%CI:0.79,0.90), grip strength [HR:0.77(95%CI:0.72,0.82)] and ALM/height2 [HR:0.85(95%CI:0.80,0.90)] were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but that between ALM/height2 and MOF was weakened [HR:0.92(95%CI:0.85,0.99]. Inclusion of femoral neck BMD markedly attenuated the association between ALM/height2 and MOF [HR:1.02(95%CI:0.96,1.10)]. Measures of physical performance predict incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height2 being substantially reduced by inclusion of BMD requires further study, these findings support the consideration of physical performance in fracture risk assessment.

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nch MrOS mobility fracture R2 23_06_2018 clean - Accepted Manuscript
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Accepted/In Press date: 7 July 2018
e-pub ahead of print date: 16 July 2018

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Local EPrints ID: 422297
URI: https://eprints.soton.ac.uk/id/eprint/422297
ISSN: 0884-0431
PURE UUID: c9ed5eb4-4ca1-40ef-99ca-0e302e4b8c97
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 20 Jul 2018 16:30
Last modified: 10 Dec 2019 05:18

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Contributors

Author: Nicholas Harvey ORCID iD
Author: Anders Odén
Author: Eric Orwoll
Author: Jodi Lapidus
Author: Timothy Kwok
Author: Magnus Karlsson
Author: Bjorn E. Rosengren
Author: Eva Ribom
Author: Cyrus Cooper ORCID iD
Author: Peggy M. Cawthon
Author: John A. Kanis
Author: Claes Ohlsson
Author: Dan Mellström
Author: Helena Johansson
Author: Eugene McCloskey

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