The University of Southampton
×
Filter your search:
University of Southampton Institutional Repository

Predictive value of DXA appendicular lean mass for incident fractures, falls and mortality, independent of prior falls, FRAX and BMD: Findings from the Women’s Health Initiative (WHI)

Predictive value of DXA appendicular lean mass for incident fractures, falls and mortality, independent of prior falls, FRAX and BMD: Findings from the Women’s Health Initiative (WHI)
Predictive value of DXA appendicular lean mass for incident fractures, falls and mortality, independent of prior falls, FRAX and BMD: Findings from the Women’s Health Initiative (WHI)

In the Women's Health Initiative (WHI), we investigated associations between baseline dual-energy X-ray absorptiometry (DXA) appendicular lean mass (ALM) and risk of incident fractures, falls, and mortality (separately for each outcome) among older postmenopausal women, accounting for bone mineral density (BMD), prior falls, and Fracture Risk Assessment Tool (FRAX ®) probability. The WHI is a prospective study of postmenopausal women undertaken at 40 US sites. We used an extension of Poisson regression to investigate the relationship between baseline ALM (corrected for height 2) and incident fracture outcomes, presented here for major osteoporotic fracture (MOF: hip, clinical vertebral, forearm, or proximal humerus), falls, and death. Associations were adjusted for age, time since baseline and randomization group, or additionally for femoral neck (FN) BMD, prior falls, or FRAX probability (MOF without BMD) and are reported as gradient of risk (GR: hazard ratio for first incident fracture per SD increment) in ALM/height 2 (GR). Data were available for 11,187 women (mean [SD] age 63.3 [7.4] years). In the base models (adjusted for age, follow-up time, and randomization group), greater ALM/height 2 was associated with lower risk of incident MOF (GR = 0.88; 95% confidence interval [CI] 0.83–0.94). The association was independent of prior falls but was attenuated by FRAX probability. Adjustment for FN BMD T-score led to attenuation and inversion of the risk relationship (GR = 1.06; 95% CI 0.98–1.14). There were no associations between ALM/height 2 and incident falls. However, there was a 7% to 15% increase in risk of death during follow-up for each SD greater ALM/height 2, depending on specific adjustment. In WHI, and consistent with our findings in older men (Osteoporotic Fractures in Men [MrOS] study cohorts), the predictive value of DXA-ALM for future clinical fracture is attenuated (and potentially inverted) after adjustment for femoral neck BMD T-score. However, intriguing positive, but modest, associations between ALM/height 2 and mortality remain robust.

APPENDICULAR LEAN MASS, BMD, DXA, FRACTURE, FRAX, OSTEOPOROSIS: EPIDEMIOLOGY
0884-0431
654-661
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Bea, Jennifer W.
eb42a627-054b-4430-9623-eb7e7ae2398c
Carbone, Laura
4ec9e12d-a78c-4129-b725-c8c37fba5fa7
Cespedes Feliciano, Elizabeth M.
2e94e3ba-3ab3-4ed4-9b2d-9b9d3215649f
Laddu, Deepika R.
30956f3f-39e3-4a09-8bd8-cb04f0e480f1
Schnatz, Peter F.
d08d4fea-eab1-424d-8961-8a39555faad8
Shadyab, Aladdin H.
ae15a3ce-f625-4485-a0b0-f05c12152644
Stefanick, Marcia L
3f0f9c21-d37d-4418-8f87-d8a29c006a09
Wactawski-Wende, Jean
fd8d4e87-a3a9-43f7-97b9-41a003a02ce5
Crandall, Carolyn J.
e768154e-60be-4e70-8398-d080f87d0fff
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Bea, Jennifer W.
eb42a627-054b-4430-9623-eb7e7ae2398c
Carbone, Laura
4ec9e12d-a78c-4129-b725-c8c37fba5fa7
Cespedes Feliciano, Elizabeth M.
2e94e3ba-3ab3-4ed4-9b2d-9b9d3215649f
Laddu, Deepika R.
30956f3f-39e3-4a09-8bd8-cb04f0e480f1
Schnatz, Peter F.
d08d4fea-eab1-424d-8961-8a39555faad8
Shadyab, Aladdin H.
ae15a3ce-f625-4485-a0b0-f05c12152644
Stefanick, Marcia L
3f0f9c21-d37d-4418-8f87-d8a29c006a09
Wactawski-Wende, Jean
fd8d4e87-a3a9-43f7-97b9-41a003a02ce5
Crandall, Carolyn J.
e768154e-60be-4e70-8398-d080f87d0fff
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
McCloskey, Eugene
6d3df4aa-b438-4a83-bd06-06b6cbe3980f

Harvey, Nicholas, Kanis, John A., Liu, Enwu, Cooper, Cyrus, Lorentzon, Mattias, Bea, Jennifer W., Carbone, Laura, Cespedes Feliciano, Elizabeth M., Laddu, Deepika R., Schnatz, Peter F., Shadyab, Aladdin H., Stefanick, Marcia L, Wactawski-Wende, Jean, Crandall, Carolyn J., Johansson, Helena and McCloskey, Eugene (2021) Predictive value of DXA appendicular lean mass for incident fractures, falls and mortality, independent of prior falls, FRAX and BMD: Findings from the Women’s Health Initiative (WHI). Journal of Bone and Mineral Research, 36 (4), 654-661. (doi:10.1002/jbmr.4239).

Record type: Article

Abstract

In the Women's Health Initiative (WHI), we investigated associations between baseline dual-energy X-ray absorptiometry (DXA) appendicular lean mass (ALM) and risk of incident fractures, falls, and mortality (separately for each outcome) among older postmenopausal women, accounting for bone mineral density (BMD), prior falls, and Fracture Risk Assessment Tool (FRAX ®) probability. The WHI is a prospective study of postmenopausal women undertaken at 40 US sites. We used an extension of Poisson regression to investigate the relationship between baseline ALM (corrected for height 2) and incident fracture outcomes, presented here for major osteoporotic fracture (MOF: hip, clinical vertebral, forearm, or proximal humerus), falls, and death. Associations were adjusted for age, time since baseline and randomization group, or additionally for femoral neck (FN) BMD, prior falls, or FRAX probability (MOF without BMD) and are reported as gradient of risk (GR: hazard ratio for first incident fracture per SD increment) in ALM/height 2 (GR). Data were available for 11,187 women (mean [SD] age 63.3 [7.4] years). In the base models (adjusted for age, follow-up time, and randomization group), greater ALM/height 2 was associated with lower risk of incident MOF (GR = 0.88; 95% confidence interval [CI] 0.83–0.94). The association was independent of prior falls but was attenuated by FRAX probability. Adjustment for FN BMD T-score led to attenuation and inversion of the risk relationship (GR = 1.06; 95% CI 0.98–1.14). There were no associations between ALM/height 2 and incident falls. However, there was a 7% to 15% increase in risk of death during follow-up for each SD greater ALM/height 2, depending on specific adjustment. In WHI, and consistent with our findings in older men (Osteoporotic Fractures in Men [MrOS] study cohorts), the predictive value of DXA-ALM for future clinical fracture is attenuated (and potentially inverted) after adjustment for femoral neck BMD T-score. However, intriguing positive, but modest, associations between ALM/height 2 and mortality remain robust.

Text
nch FRAX WHI ALM paper 2021_01_05 R2 clean - Accepted Manuscript
Available under License University of Southampton Accepted Manuscript Licence.
Download (145kB)

More information

Accepted/In Press date: 23 December 2020
e-pub ahead of print date: 15 January 2021
Published date: April 2021
Additional Information: Funding Information: We thank the participants of the Women's Health Initiative. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. The work was also supported by the UK Medical Research Council (4050502589 [MRC LEU]). WHI project: 3572. DRL was supported by National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K01HL148503. Funding Information: We thank the participants of the Women's Health Initiative. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201600018C, HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. The work was also supported by the UK Medical Research Council (4050502589 [MRC LEU]). WHI project: 3572. DRL was supported by National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number K01HL148503. Author contributions: Nicholas Harvey: Conceptualization; formal analysis; methodology; project administration; supervision; writing-original draft; writing-review and editing. John Kanis: Conceptualization; data curation; methodology; project administration; resources; writing-original draft; writing-review and editing. Enwu Liu: Formal analysis; methodology; writing-review and editing. Cyrus Cooper: Methodology; writing-review and editing. Mattias Lorentzon: Conceptualization; investigation; methodology; project administration; writing-original draft; writing-review and editing. Jennifer Bea: Conceptualization; methodology; writing-review and editing. Laura Carbone: Conceptualization; methodology; writing-review and editing. Deepika Laddu: Conceptualization; methodology; writing-review and editing. Peter Schnatz: Conceptualization; methodology; writing-review and editing. Aladdin Shadyab: Conceptualization; methodology; writing-review and editing. Marcia Stefanick: Conceptualization; methodology; writing-review and editing. Jean Wactawski-Wende: Conceptualization; methodology; writing-review and editing. Carolyn Crandall: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; writing-review and editing. Helena Johansson: Conceptualization; data curation; formal analysis; methodology; project administration; resources; writing-original draft; writing-review and editing. Conceptualization; methodology; project administration; resources; supervision; writing-original draft; writing-review and editing. Publisher Copyright: © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)
Keywords: APPENDICULAR LEAN MASS, BMD, DXA, FRACTURE, FRAX, OSTEOPOROSIS: EPIDEMIOLOGY
Learn more about Institute for Life Sciences research

Identifiers

Local EPrints ID: 446357
URI: http://eprints.soton.ac.uk/id/eprint/446357
DOI: doi:10.1002/jbmr.4239
ISSN: 0884-0431
PURE UUID: e00590ac-1e5d-4b7c-b4a8-471a981047c0
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 05 Feb 2021 17:31
Last modified: 18 Mar 2024 05:03

Export record

Altmetrics

Contributors

Author: Nicholas Harvey ORCID iD
Author: John A. Kanis
Author: Enwu Liu
Author: Cyrus Cooper ORCID iD
Author: Mattias Lorentzon
Author: Jennifer W. Bea
Author: Laura Carbone
Author: Elizabeth M. Cespedes Feliciano
Author: Deepika R. Laddu
Author: Peter F. Schnatz
Author: Aladdin H. Shadyab
Author: Marcia L Stefanick
Author: Jean Wactawski-Wende
Author: Carolyn J. Crandall
Author: Helena Johansson
Author: Eugene McCloskey

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Library staff additional information
Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×