title: High fracture probability predicts fractures in a 4-year follow-up in women from the RAC-OST-POL study.
abstract: In 770 postmenopausal women, the fracture incidence during a 4-year follow-up was analyzed in relation to the fracture probability (FRAX risk assessment tool) and risk (Garvan risk calculator) predicted at baseline. Incident fractures occurred in 62 subjects with a higher prevalence in high-risk subgroups. Prior fracture, rheumatoid arthritis, femoral neck T-score and falls increased independent of fracture incidence.
  
  
  BACKGROUND
  The aim of the study was to analyze the incidence of fractures during a 4-year follow-up in relation to the baseline fracture probability and risk.
  
  
  METHODS
  Enrolled in the study were 770 postmenopausal women with a mean age of 65.7 ± 7.3 years. Bone mineral density (BMD) at the proximal femur, clinical data, and fracture probability using the FRAX tool and risk using the Garvan calculator were determined. Each subject was asked yearly by phone call about the incidence of fracture during the follow-up period.
  
  
  RESULTS
  Of the 770 women, 62 had a fracture during follow-up, and 46 had a major fracture. At baseline, BMD was significantly lower, and fracture probability and fracture risk were significantly higher in women who had a fracture. Among women with a major fracture, the percentage with a high baseline fracture probability (>10 %) was significantly higher than among those without a fracture (p < 0.01). Fracture incidence during follow-up was significantly higher among women with a high baseline fracture probability (12.7 % vs. 5.2 %) and a high fracture risk (9.2 vs. 5.3 %) so that the "fracture-free survival" curves were significantly different (p < 0.05). The number of clinical risk factors noted at baseline was significantly associated with fracture incidence (chi-squared = 20.82, p < 0.01). Prior fracture, rheumatoid arthritis, and femoral neck T-score were identified as significant risk factors for major fractures (for any fractures, the influence of falls was also significant).
  
  
  CONCLUSIONS
  During follow-up, fracture incidence was predicted by baseline fracture probability (FRAX risk assessment tool) and risk (Garvan risk calculator). A number of clinical risk factors and a prior fracture, rheumatoid arthritis, femoral neck T-score, and falls were independently associated with an increased incidence of fractures. [Corrected]
authors.affiliation: School of Medicine with the Division of Dentistry, Metabolic Bone Diseases Unit, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia in Katowice, 3-Maja 13/15 street, 41-800, Zabrze, Poland. osteolesna@poczta.onet.pl.
authors.forename: W
authors.initials: W
authors.lastname: Pluskiewicz
authors.affiliation: School of Medicine with the Division of Dentistry, Department and Clinic of Pediatrics, Medical University of Silesia in Katowice, Zabrze, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Adamczyk
authors.affiliation: Department of Nephrology, Wodzisław, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Czekajło
authors.affiliation: School of Medicine with the Division of Dentistry, Department and Clinic of Internal Diseases, Diabetology and Nephrology, Medical University of Silesia in Katowice, Zabrze, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Grzeszczak
authors.affiliation: School of Medicine with the Division of Dentistry, Department of Pathomorphology, Medical University of Silesia in Katowice, Zabrze, Poland.
authors.forename: B
authors.initials: B
authors.lastname: Drozdzowska
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D015519:Bone Density / Q000502:physiology; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000503:physiopathology; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
keywords: Follow-up; Fracture; Fracture probability; Fracture risk; Women