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Measured height loss predicts incident clinical fractures independently from FRAX: a registry-based cohort study

Measured height loss predicts incident clinical fractures independently from FRAX: a registry-based cohort study
Measured height loss predicts incident clinical fractures independently from FRAX: a registry-based cohort study

Summary: During median follow-up 6.0 years in 11,495 individuals, prior absolute and annualized measured height loss was significantly greater in those with subsequent incident fracture compared with those without incident fracture. Purpose: FRAX® accepts baseline height and weight as input variables, but does not consider change in these parameters over time. Aim: To evaluate the association between measured height or weight loss on subsequent fracture risk adjusted for FRAX scores, risk factors, and competing mortality. Methods: Using a dual-energy x-ray absorptiometry (DXA) registry for the Province of Manitoba, Canada, we identified women and men age 40 years or older with height and weight measured at the time of two DXA scans. Cox regression analyses were performed to test for a covariate-adjusted association between prior height and weight loss with incident fractures occurring after the second scan using linked population-based healthcare data. Results: The study population consisted of 11,495 individuals (average age 68.0 ± 9.9 years, 94.6% women). During median follow-up 6.0 years, records demonstrated incident major osteoporotic fracture (MOF) in 869 individuals, hip fractures in 265, clinical vertebral fractures in 207, and any fracture in 1203. Prior height loss was significantly greater in individuals with fracture compared with those without fracture, regardless of fracture site. Mortality was greater in those with prior height loss (HR per SD 1.11, 95% CI 1.06–1.17) or weight loss (HR per SD 1.26, 95% CI 1.19–1.32). Each SD in height loss was associated with increased fracture risk (MOF 12–17%, hip 8–19%, clinical vertebral 28–37%, any fracture 14–19%). Prior weight loss was associated with 21–30% increased risk for hip fracture, but did not increase risk for other fractures. Height loss of 3.0 cm or greater more than doubled the risk for subsequent fracture. Conclusions: Prior height loss is associated with a small but significant increase in risk of incident fracture at all skeletal sites independent of other clinical risk factors and competing mortality as considered by FRAX. Prior weight loss only increases risk for subsequent hip fracture.

Dual-energy x-ray absorptiometry, Fractures, FRAX, Height, Osteoporosis
0937-941X
1079-1087
Leslie, W. D.
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Schousboe, J. T.
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Morin, S. N.
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Martineau, P.
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Lix, L. M.
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Johansson, H.
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McCloskey, E. V.
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Harvey, N. C.
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Kanis, J. A.
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Leslie, W. D.
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Schousboe, J. T.
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Morin, S. N.
68489af8-f604-4f28-88e0-60add9fde4ae
Martineau, P.
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Lix, L. M.
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Johansson, H.
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McCloskey, E. V.
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Harvey, N. C.
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Kanis, J. A.
ec5ad011-1ed5-43e9-acac-b0d4f535f5b1

Leslie, W. D., Schousboe, J. T., Morin, S. N., Martineau, P., Lix, L. M., Johansson, H., McCloskey, E. V., Harvey, N. C. and Kanis, J. A. (2020) Measured height loss predicts incident clinical fractures independently from FRAX: a registry-based cohort study. Osteoporosis International, 31 (6), 1079-1087. (doi:10.1007/s00198-020-05313-3).

Record type: Article

Abstract

Summary: During median follow-up 6.0 years in 11,495 individuals, prior absolute and annualized measured height loss was significantly greater in those with subsequent incident fracture compared with those without incident fracture. Purpose: FRAX® accepts baseline height and weight as input variables, but does not consider change in these parameters over time. Aim: To evaluate the association between measured height or weight loss on subsequent fracture risk adjusted for FRAX scores, risk factors, and competing mortality. Methods: Using a dual-energy x-ray absorptiometry (DXA) registry for the Province of Manitoba, Canada, we identified women and men age 40 years or older with height and weight measured at the time of two DXA scans. Cox regression analyses were performed to test for a covariate-adjusted association between prior height and weight loss with incident fractures occurring after the second scan using linked population-based healthcare data. Results: The study population consisted of 11,495 individuals (average age 68.0 ± 9.9 years, 94.6% women). During median follow-up 6.0 years, records demonstrated incident major osteoporotic fracture (MOF) in 869 individuals, hip fractures in 265, clinical vertebral fractures in 207, and any fracture in 1203. Prior height loss was significantly greater in individuals with fracture compared with those without fracture, regardless of fracture site. Mortality was greater in those with prior height loss (HR per SD 1.11, 95% CI 1.06–1.17) or weight loss (HR per SD 1.26, 95% CI 1.19–1.32). Each SD in height loss was associated with increased fracture risk (MOF 12–17%, hip 8–19%, clinical vertebral 28–37%, any fracture 14–19%). Prior weight loss was associated with 21–30% increased risk for hip fracture, but did not increase risk for other fractures. Height loss of 3.0 cm or greater more than doubled the risk for subsequent fracture. Conclusions: Prior height loss is associated with a small but significant increase in risk of incident fracture at all skeletal sites independent of other clinical risk factors and competing mortality as considered by FRAX. Prior weight loss only increases risk for subsequent hip fracture.

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Accepted/In Press date: 22 January 2020
e-pub ahead of print date: 3 February 2020
Keywords: Dual-energy x-ray absorptiometry, Fractures, FRAX, Height, Osteoporosis

Identifiers

Local EPrints ID: 438013
URI: http://eprints.soton.ac.uk/id/eprint/438013
ISSN: 0937-941X
PURE UUID: 19d51e85-295a-4126-bd9c-16df6ee1a677
ORCID for N. C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 26 Feb 2020 17:30
Last modified: 26 Nov 2021 05:59

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Contributors

Author: W. D. Leslie
Author: J. T. Schousboe
Author: S. N. Morin
Author: P. Martineau
Author: L. M. Lix
Author: H. Johansson
Author: E. V. McCloskey
Author: N. C. Harvey ORCID iD
Author: J. A. Kanis

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