Evaluation of easily measured risk factors in the prediction of osteoporotic fractures.
BACKGROUND
Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk.


METHODS
Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including: age (< 65, 65-69, 70-74, 75-79, 80+ years), rising from a chair with arms (yes, no), weight (< 57, > or = 57 kg), maternal history of hip fracture (yes, no), prior fracture after age 50 (yes, no), hip T-score (> -1, -1 to > -2.5, < or = -2.5), and current smoking status (yes, no). Multivariable logistic regression analysis was conducted.


RESULTS
The inability to rise from a chair without the use of arms (3.58; 95% CI: 1.17, 10.93) was the most significant risk factor for new hip fracture. Notable risk factors for predicting new vertebral fractures were: low body weight (1.57; 95% CI: 1.04, 2.37), current smoking (1.95; 95% CI: 1.20, 3.18) and age between 75-79 years (1.96; 95% CI: 1.10, 3.51). New wrist fractures were significantly identified by low body weight (1.71, 95% CI: 1.01, 2.90) and prior fracture after 50 years (1.96; 95% CI: 1.19, 3.22). Predictors of new rib fractures include a maternal history of a hip fracture (2.89; 95% CI: 1.04, 8.08) and a prior fracture after 50 years (2.16; 95% CI: 1.20, 3.87).


CONCLUSIONS
This study has shown that there exists a variety of predictors of future fracture, besides BMD, that can be easily assessed by a physician. The significance of each variable depends on the site of incident fracture. Of greatest interest is that an inability to rise from a chair is perhaps the most readily identifiable significant risk factor for hip fracture and can be easily incorporated into routine clinical practice.
Bensen
Robert
R
Medical Science, McMaster University, Hamilton, Ontario, Canada. bensenrw@gmail.com
Adachi
Jonathan D
JD
Papaioannou
Alexandra
A
Ioannidis
George
G
Olszynski
Wojciech P
WP
Sebaldt
Rolf J
RJ
Murray
Timothy M
TM
Josse
Robert G
RG
Brown
Jacques P
JP
Hanley
David A
DA
Petrie
Annie
A
Puglia
Mark
M
Goldsmith
Charlie H
CH
Bensen
W
W
D000368:Aged; D000375:Aging; D001835:Body Weight; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006620:Hip Fractures / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008499:Medical Records; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D011379:Prognosis; D011446:Prospective Studies; D012253:Rib Fractures / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016103:Spinal Fractures / Q000209:etiology; D014954:Wrist Injuries / Q000209:etiology