Empirically Based Composite Fracture Prediction Model From the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW)

被引：15

作者：

FitzGerald, Gordon ^{[1
]}

Compston, Juliet E. ^{[2
]}

Chapurlat, Roland D. ^{[3
,4
]}

Pfeilschifter, Johannes ^{[5
]}

Cooper, Cyrus ^{[6
,7
]}

Hosmer, David W., Jr. ^{[1
]}

Adachi, Jonathan D. ^{[8
]}

Anderson, Frederick A., Jr. ^{[1
]}

Diez-Perez, Adolfo ^{[9
]}

Greenspan, Susan L. ^{[10
]}

Netelenbos, J. Coen ^{[11
]}

Nieves, Jeri W. ^{[12
,13
]}

Rossini, Maurizio ^{[14
]}

Watts, Nelson B. ^{[15
]}

Hooven, Frederick H. ^{[1
]}

LaCroix, Andrea Z. ^{[16
]}

March, Lyn ^{[17
,18
]}

Roux, Christian ^{[19
,20
]}

Saag, Kenneth G. ^{[21
]}

Siris, Ethel S. ^{[22
]}

Silverman, Stuart ^{[23
]}

Gehlbach, Stephen H. ^{[1
]}

机构：

[1] Univ Massachusetts, Sch Med, Ctr Outcomes Res, Worcester, MA 01605 USA

[2] Univ Cambridge, Sch Clin Med, Addenbrookes Hosp, Cambridge CB2 0QQ, England

[3] Univ Lyon, Div Rheumatol, INSERM, Unite Mixte Rech 1033, F-69003 Lyon, France

[4] Hop Edouard Herriot, Dept Orthoped & Rheumatol, F-69003 Lyon, France

[5] Alfried Krupp Hosp, Dept Internal Med 3, D-45276 Essen, Germany

[6] Univ Southampton, Southampton Gen Hosp, Lifecourse Epidemiol Unit, MRC, Southampton SO16 6YD, Hants, England

[7] Univ Oxford, Natl Inst Hlth Res, Musculoskeletal Biomed Res Unit, Oxford OX1 3QX, England

[8] McMaster Univ, St Josephs Hosp, Hamilton, ON L8N 1Y2, Canada

[9] Autonomous Univ Barcelona, Hosp del Mar, IMIM, E-08035 Barcelona, Spain

[10] Univ Pittsburgh, Pittsburgh, PA 15213 USA

[11] Vrije Univ Amsterdam, Med Ctr, Dept Endocrinol, NL-2131 PM Amsterdam, Netherlands

[12] Helen Hayes Hosp, W Haverstraw, NY 10993 USA

[13] Columbia Univ, W Haverstraw, NY 10993 USA

[14] Univ Verona, Dept Med, Rheumatol Sect, I-37129 Verona, Italy

[15] Mercy Hlth, Cincinnati, OH 45236 USA

[16] Fred Hutchinson Canc Res Ctr, Seattle, WA 98109 USA

[17] Univ Sydney, Inst Bone & Joint Res, Sydney, NSW 2006, Australia

[18] Univ Sydney, Royal N Shore Hosp, Dept Rheumatol, Sydney, NSW 2006, Australia

[19] Paris Descartes Univ, F-75014 Paris, France

[20] Cochin Hosp, F-75014 Paris, France

[21] Univ Alabama Birmingham, Div Clin Immunol & Rheumatol, Birmingham, AL 35294 USA

[22] Columbia Univ, Med Ctr, New York, NY 10032 USA

[23] Cedars Sinai Med Ctr, Dept Rheumatol, Los Angeles, CA 90211 USA

来源：

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM | 2014年 / 99卷 / 03期

关键词：

RISK; OBESITY; FRAX; BMD;

D O I：

10.1210/jc.2013-3468

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Context: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired. Objective: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles. Design: This was a prospective, observational cohort study. Setting: The study was conducted at primary care practices in 10 countries. Patients: Women aged 55 years or older participated in the study. Intervention: Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures. Main Outcome Measure: The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age. Results: Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase. Conclusions: After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model.

引用

页码：817 / 826

页数：10

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