Adjusting conventional FRAX estimates of fracture probability according to the number of prior falls in the preceding year
Adjusting conventional FRAX estimates of fracture probability according to the number of prior falls in the preceding year
Summary: Aagreater propensity to falling is associated with higher fracture risk. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior falls. Introduction: Prior falls increase subsequent fracture risk but are not currently directly included in the FRAX tool. The aim of this study was to quantify the effect of the number of prior falls on the 10-year probability of fracture determined with FRAX®.
Methods: we studied 21,116 women and men age 40 years or older (mean age 65.7 ± 10.1 years) with fracture probability assessment (FRAX®), self-reported falls for the previous year, and subsequent fracture outcomes in a registry-based cohort. The risks of death, hip fracture, and non-hip major osteoporotic fracture (MOF-NH) were determined by Cox proportional hazards regression for fall number category versus the whole population (i.e., an average number of falls). Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of falls from the hazards of death and fracture incorporated into the FRAX model for the UK. The probability ratios (number of falls vs. average number of falls) provided adjustments to conventional FRAX estimates of fracture probability according to the number of falls.
Results: compared with the average number of falls, the hazard ratios for hip fracture, MOF-NH and death were lower than unity in the absence of a fall history. Hazard ratios increased progressively with an increasing number of reported falls. The probability ratio rose progressively as the number of reported falls increased. Probability ratios decreased with age, an effect that was more marked the greater the number of prior falls.
Conclusion: the probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior falls.
Fracture probability, FRAX adjustment, Prior falls, Risk assessment
479-487
Kanis, John A.
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Johansson, Helena
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Harvey, Nicholas C.
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Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Liu, Enwu
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Vandenput, Liesbeth
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Morin, Suzanne
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Leslie, William D.
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McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
23 December 2022
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Liu, Enwu
08027c15-9e71-44bb-9623-3081f5f6492d
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
Morin, Suzanne
68489af8-f604-4f28-88e0-60add9fde4ae
Leslie, William D.
5b2dd5d6-4569-40a3-a9b1-95152d11e4f1
McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Kanis, John A., Johansson, Helena, Harvey, Nicholas C., Lorentzon, Mattias, Liu, Enwu, Vandenput, Liesbeth, Morin, Suzanne, Leslie, William D. and McCloskey, Eugene V.
(2022)
Adjusting conventional FRAX estimates of fracture probability according to the number of prior falls in the preceding year.
Osteoporosis International, 34 (3), .
(doi:10.1007/s00198-022-06633-2).
Abstract
Summary: Aagreater propensity to falling is associated with higher fracture risk. This study provides adjustments to FRAX-based fracture probabilities accounting for the number of prior falls. Introduction: Prior falls increase subsequent fracture risk but are not currently directly included in the FRAX tool. The aim of this study was to quantify the effect of the number of prior falls on the 10-year probability of fracture determined with FRAX®.
Methods: we studied 21,116 women and men age 40 years or older (mean age 65.7 ± 10.1 years) with fracture probability assessment (FRAX®), self-reported falls for the previous year, and subsequent fracture outcomes in a registry-based cohort. The risks of death, hip fracture, and non-hip major osteoporotic fracture (MOF-NH) were determined by Cox proportional hazards regression for fall number category versus the whole population (i.e., an average number of falls). Ten-year probabilities of hip fracture and major osteoporotic fracture (MOF) were determined according to the number of falls from the hazards of death and fracture incorporated into the FRAX model for the UK. The probability ratios (number of falls vs. average number of falls) provided adjustments to conventional FRAX estimates of fracture probability according to the number of falls.
Results: compared with the average number of falls, the hazard ratios for hip fracture, MOF-NH and death were lower than unity in the absence of a fall history. Hazard ratios increased progressively with an increasing number of reported falls. The probability ratio rose progressively as the number of reported falls increased. Probability ratios decreased with age, an effect that was more marked the greater the number of prior falls.
Conclusion: the probability ratios provide adjustments to conventional FRAX estimates of fracture probability according to the number of prior falls.
Text
Number of prior fractures OSIN R1109352
- Accepted Manuscript
More information
Accepted/In Press date: 1 December 2022
Published date: 23 December 2022
Additional Information:
Funding Information:
The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017- 29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, 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.
Keywords:
Fracture probability, FRAX adjustment, Prior falls, Risk assessment
Identifiers
Local EPrints ID: 476865
URI: http://eprints.soton.ac.uk/id/eprint/476865
ISSN: 0937-941X
PURE UUID: 69e8549a-ca07-49a1-a4ec-38ef441d94dc
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Date deposited: 18 May 2023 16:39
Last modified: 18 Mar 2024 05:30
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Contributors
Author:
John A. Kanis
Author:
Helena Johansson
Author:
Mattias Lorentzon
Author:
Enwu Liu
Author:
Liesbeth Vandenput
Author:
Suzanne Morin
Author:
William D. Leslie
Author:
Eugene V. McCloskey
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