title: Independent predictors of all osteoporosis-related fractures among healthy Saudi postmenopausal women: the CEOR Study.
abstract: This study was designed to identify independent predictors of all osteoporosis-related fractures (ORFs) among healthy Saudi postmenopausal women. We prospectively followed a cohort of 707 healthy postmenopausal women (mean age, 61.3±7.2 years) for 5.2±1.3 years. Data were collected on demographic characteristics, medical history, personal and family history of fractures, lifestyle factors, daily calcium intake, vitamin D supplementation, and physical activity score. Anthropometric parameters, total fractures (30.01 per 1000 women/year), special physical performance tests, bone turnover markers, hormone levels, and bone mineral density (BMD) measurements were performed. The final model consisted of seven independent predictors of ORFs: [lowest quartile (Q(1)) vs highest quartile (Q(4))] physical activity score (Q(1) vs Q(4): ≤12.61 vs ≥15.38); relative risk estimate [RR], 2.87; (95% confidence interval [CI]: 1.88-4.38); age≥60 years vs age<60 years (RR=2.43; 95% CI: 1.49-3.95); hand grip strength (Q(1) vs Q(4): ≤13.88 vs ≥17.28 kg) (RR=1.88; 95% CI: 1.15-3.05); BMD total hip (Q(1) vs Q(4): ≤0.784 vs 0.973 g/cm(2)) (RR=1.86; 95% CI: 1.26-2.75); dietary calcium intake (Q(1) vs Q(4): ≤391 vs ≥648 mg/day) (RR=1.66; 95% CI: 1.08-2.53); serum 25(OH)D (Q(1) vs Q(4): ≤17.9 vs ≥45.1 nmol/L) (RR=1.63; 95% CI: 1.06-2.51); and past year history of falls (RR=1.61; 95% CI: 1.06-2.48). Compared with having none (41.9% of women), having three or more clinical risk factors (4.8% of women) increased fracture risk by more than 4-fold, independent of BMD. Having three or more risk factors and being in the lowest tertile of T-score of [total hip/lumbar spine (L1-L4)] was associated with a 14.2-fold greater risk than having no risk factors and being in the highest T-score tertile. Several clinical risk factors were independently associated with all ORFs in healthy Saudi postmenopausal women. The combination of multiple clinical risk factors and low BMD is a very powerful indicator of fracture risk.
authors.affiliation: Center of Excellence for Osteoporosis Research, King Abdulaziz University, Jeddah, Saudi Arabia. aarouzi@gmail.com
authors.forename: Abdulrahim A
authors.initials: AA
authors.lastname: Rouzi
authors.forename: Sharifa A
authors.initials: SA
authors.lastname: Al-Sibiani
authors.forename: Nawal S
authors.initials: NS
authors.lastname: Al-Senani
authors.forename: Raja M
authors.initials: RM
authors.lastname: Radaddi
authors.forename: Mohammed-Salleh M
authors.initials: MS
authors.lastname: Ardawi
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology*; D002136:Calcium, Dietary; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications*; D058866:Osteoporotic Fractures / Q000209:etiology*; D017698:Postmenopause; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012529:Saudi Arabia; D016387:Women's Health
chemical_list: D002136:Calcium, Dietary