The effect of fracture recency on observed 10-year fracture probability: a registry-based cohort study
The effect of fracture recency on observed 10-year fracture probability: a registry-based cohort study
FRAX estimates 10-year fracture major osteoporotic fracture (MOF) and hip fracture probability from multiple risk factors. FRAX does not consider prior fracture site or time since fracture. Fracture risk is greater in the initial 2-year post-fracture period (imminent risk), implying that FRAX may underestimate risk in this setting. We used the population-based Manitoba Bone Mineral Density (BMD) Program registry to examine the effect of fracture recency and site on incident fracture risk predictions using FRAX. We identified women aged 40 years or older with baseline BMD and FRAX scores. Observed fracture outcomes to 10 years were compared with predicted 10-year fracture probability stratified by prior fracture status: none, recent (<2 years [median 0.3 years]), and remote (≥2 years [median 10.6 years]). For women with recent fractures, we also examined proposed multipliers to adjust FRAX for the effect of fracture recency and site. The cohort comprised 33,465 women aged 40 to 64 years (1897 recent fracture, 2120 remote fracture) and 33,806 women aged ≥65 years (2365 fracture, 4135 remote fracture). Observed fracture probability was consistent with predicted probability in most analyses. In women aged 40 to 64 years, there was a significant effect of recent vertebral and humerus fracture on MOF (observed to predicted 1.61 and 1.48, respectively), but these effects were still lower than the proposed multipliers (2.32 and 1.67, respectively). No significant effect of fracture recency was found after hip or forearm fracture in either age group. Our findings contribute to accumulating evidence of the importance of recent fracture. The effect of fracture recency was not consistent across fracture sites and with a lower magnitude than previously reported. Further quantification of effect size and specificity in additional independent cohorts is warranted to validate and refine recent-fracture multipliers in fracture risk assessment.
FRACTURE, FRAX, IMMINENT RISK, MAJOR OSTEOPOROTIC FRACTURE, OSTEOPOROSIS, POPULATION-BASED COHORT STUDY
848-855
Leslie, William D.
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Morin, Suzanne N
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Lix, Lisa M.
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McCloskey, Eugene V.
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Johansson, Helena
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Harvey, Nicholas
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Kanis, John A.
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May 2022
Leslie, William D.
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Morin, Suzanne N
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Lix, Lisa M.
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McCloskey, Eugene V.
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Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
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Leslie, William D., Morin, Suzanne N, Lix, Lisa M., McCloskey, Eugene V., Johansson, Helena, Harvey, Nicholas and Kanis, John A.
(2022)
The effect of fracture recency on observed 10-year fracture probability: a registry-based cohort study.
Journal of Bone and Mineral Research, 37 (5), .
(doi:10.1002/jbmr.4526).
Abstract
FRAX estimates 10-year fracture major osteoporotic fracture (MOF) and hip fracture probability from multiple risk factors. FRAX does not consider prior fracture site or time since fracture. Fracture risk is greater in the initial 2-year post-fracture period (imminent risk), implying that FRAX may underestimate risk in this setting. We used the population-based Manitoba Bone Mineral Density (BMD) Program registry to examine the effect of fracture recency and site on incident fracture risk predictions using FRAX. We identified women aged 40 years or older with baseline BMD and FRAX scores. Observed fracture outcomes to 10 years were compared with predicted 10-year fracture probability stratified by prior fracture status: none, recent (<2 years [median 0.3 years]), and remote (≥2 years [median 10.6 years]). For women with recent fractures, we also examined proposed multipliers to adjust FRAX for the effect of fracture recency and site. The cohort comprised 33,465 women aged 40 to 64 years (1897 recent fracture, 2120 remote fracture) and 33,806 women aged ≥65 years (2365 fracture, 4135 remote fracture). Observed fracture probability was consistent with predicted probability in most analyses. In women aged 40 to 64 years, there was a significant effect of recent vertebral and humerus fracture on MOF (observed to predicted 1.61 and 1.48, respectively), but these effects were still lower than the proposed multipliers (2.32 and 1.67, respectively). No significant effect of fracture recency was found after hip or forearm fracture in either age group. Our findings contribute to accumulating evidence of the importance of recent fracture. The effect of fracture recency was not consistent across fracture sites and with a lower magnitude than previously reported. Further quantification of effect size and specificity in additional independent cohorts is warranted to validate and refine recent-fracture multipliers in fracture risk assessment.
Text
J of Bone Mineral Res - 2022 - Leslie - The Effect of Fracture Recency on Observed 10‐year Fracture Probability A
- Accepted Manuscript
More information
Accepted/In Press date: 4 February 2022
Published date: May 2022
Additional Information:
Funding Information:
The authors acknowledge the Manitoba Centre for Health Policy (MCHP) for use of data contained in the Population Health Research Data Repository (HIPC project number 2016/2017‐29). The results and conclusions are those of the authors, and no official endorsement by the MCHP, Manitoba Health, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. No funding was received for this study. SNM is a scholar of the Fonds de Recherche du Québec en Santé and LML is supported by a Tier 1 Canada Research Chair.
Funding Information:
EVM: Nothing to declare for the context of this article but has received ad hoc consultancies/speaking honoraria and/or research funding from Amgen, Bayer, General Electric, GSK, Fresenius Kabi, Hologic, Lilly, Merck Research Labs, Novartis, Novo Nordisk, Nycomed, Ono, Pfizer, ProStrakan, Roche, Sanofi‐Aventis, Servier, Tethys, UCB, and Warner‐Chilcott. NCH: Nothing to declare for the context of this article but has received consultancy/lecture fees/honoraria/grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, UCB, Consilient Healthcare, Radius Health, Kyowa Kirin and Internis Pharma. JAK is the architect of FRAX but has no financial interest. WDL, SNM, LML, and HJ state that they have no conflicts of interest.
Funding Information:
The authors acknowledge the Manitoba Centre for Health Policy (MCHP) for use of data contained in the Population Health Research Data Repository (HIPC project number 2016/2017-29). The results and conclusions are those of the authors, and no official endorsement by the MCHP, Manitoba Health, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee. No funding was received for this study. SNM is a scholar of the Fonds de Recherche du Québec en Santé and LML is supported by a Tier 1 Canada Research Chair. Authors’ roles: WDL: conceptualization, data curation, formal analysis, investigation, methodology, project administration, writing—original draft, and writing—review and editing. SNM, LML, EVM, HJ, NCH, and JAK: methodology and writing—review and editing.
Publisher Copyright:
© 2022 American Society for Bone and Mineral Research (ASBMR).
Keywords:
FRACTURE, FRAX, IMMINENT RISK, MAJOR OSTEOPOROTIC FRACTURE, OSTEOPOROSIS, POPULATION-BASED COHORT STUDY
Identifiers
Local EPrints ID: 455334
URI: http://eprints.soton.ac.uk/id/eprint/455334
ISSN: 0884-0431
PURE UUID: b04d26cb-f48e-4d49-af97-9807e664bd9c
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Date deposited: 17 Mar 2022 17:33
Last modified: 17 Mar 2024 07:09
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Contributors
Author:
William D. Leslie
Author:
Suzanne N Morin
Author:
Lisa M. Lix
Author:
Eugene V. McCloskey
Author:
Helena Johansson
Author:
John A. Kanis
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