A family history of fracture and fracture risk: a meta-analysis

Kanis, John А.; Johansson, Helena; Odén, Anders; Johnell, Olof; Laet, Chris De; Eisman, John A.; McCloskey, Eugène; Mellström, Dan; Melton, L. Joseph; Pols, Huibert A. P.; Reeve, J.; Silman, Alan J.; Tenenhouse, Alan

doi:10.1016/j.bone.2004.06.017

Cited by 353 publications

(205 citation statements)

References 40 publications

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“…16 Several other factors are known to increase the risk for hip fracture, such as advanced age, 17 region of the world, 18 quadriceps weakness, 19 low body mass index, postural instability, 20 previous fracture, 21 female sex, and history of parent's hip fracture. [22][23][24][25] Our study, similar to several previous studies, highlights the value of some of these risk factors in hip fracture risk stratification. An Australian study found that frailty-related risk factors such as advanced age, reduced weight, quadriceps weakness, and postural instability were each associated with increased risk of hip fracture.…”

Section: Discussionsupporting

confidence: 89%

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

Albaba

Stephen

Takahashi

2012

Mayo Clinic Proceedings

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Objective: To determine whether an Elders Risk Assessment (ERA) index can predict incident hip fractures without the need for physician-patient encounter or bone mineral density testing. Patients and Methods: A retrospective cohort study was conducted in a community-based cohort of 12,650 patients aged 60 years and older. An ERA score was computed for each subject at index time (January 1, 2005). Incidents of hip fracture from January 1, 2005, through December 31, 2006, were obtained from electronic medical records. We divided the cohort into 5 groups, with the lowest ERA scores forming group A (Ͻ15%); 15% to 49%, group B; 50% to 74%, group C; 75% to 89%, group D; and the top 11%, group E. With group A as a reference group, we used logistic regression to compute odds ratios of sustaining hip fracture during a 2-year period (January 1, 2005, through December 31, 2006) for groups B, C, D, and E. Sensitivity and specificity of each possible ERA score were calculated, and a receiver operating characteristic curve was created. Results: Two hundred sixty-five patients (2.1%) sustained at least 1 hip fracture from January 1, 2005, through December 31, 2006. Odds ratios (95% confidence intervals) for groups B, C, D, and E were 1.6 (0.7-3.4), 4.5 (2.2-9.4), 6.9 (3.3-14.3), and 18.4 (8.9-37.9), respectively. The area under the receiver operating characteristic curve was 74.5%. Conclusion: An electronic medical record-based, easily derived ERA index might be useful in hip fracture risk stratification.

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Section: Discussionsupporting

confidence: 89%

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

Albaba

Stephen

Takahashi

2012

Mayo Clinic Proceedings

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“…This may be the case, in particular, for a family history of fracture, which showed a nonsignificant trend toward an increased risk of fracture in exposed women. If we hypothesize that the RR of fracture associated with a family history of hip fracture is of the same magnitude as in the FRAX cohorts (ie, 1.3), (25) we have calculated that our power to show such an RR is only 20% (risk a set at 5%). Lack of power is also evident for CRFs such as exposure to systemic glucocorticoids, high intake of alcohol, and rheumatoid arthritis, whose prevalence is very low in our sample.…”

Section: Discussionmentioning

confidence: 99%

Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: Sensitivity of the WHO FRAX tool

Trémollières

Pouillès

Drewniak

et al. 2010

Journal of Bone and Mineral Research

178

114

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The aim of this prospective study was (1) to identify significant and independent clinical risk factors (CRFs) for major osteoporotic (OP) fracture among peri-and early postmenopausal women, (2) to assess, in this population, the discriminatory capacity of FRAX and bone mineral density (BMD) for the identification of women at high risk of fracture, and (3) to assess whether adding risk factors to either FRAX or BMD would improve discriminatory capacity. The study population included 2651 peri-and early postmenopausal women [mean age (AE SD): 54 AE 4 years] with a mean follow-up period of 13.4 years (AE1.4 years). At baseline, a large set of CRFs was recorded, and vertebral BMD was measured (Lunar, DPX) in all women. Femoral neck BMD also was measured in 1399 women in addition to spine BMD. Women with current or past OP treatment for more than 3 months at baseline (n ¼ 454) were excluded from the analyses. Over the follow-up period, 415 women sustained a first low-energy fracture, including 145 major OP fractures (108 wrist, 44 spine, 20 proximal humerus, and 13 hip). In Cox multivariate regression models, only 3 CRFs were significant predictors of a major OP fracture independent of BMD and age: a personal history of fracture, three or more pregnancies, and current postmenopausal hormone therapy. In the subsample of women who had a hip BMD measurement and who were not receiving OP therapy (including hormone-replacement therapy) at baseline, mean FRAX value was 3.8% (AE2.4%). The overall discriminative value for fracture, as measured by the area under the Receiver Operating Characteristic (ROC) curve (AUC), was equal to 0.63 [95% confidence interval (CI) 0.56-0.69] and 0.66 (95% CI 0.60-0.73), respectively, for FRAX and hip BMD. Sensitivity of both tools was low (ie, around 50% for 30% of the women classified as the highest risk). Adding parity to the predictive model including FRAX or using a simple risk score based on the best predictive model in our population did not significantly improve the discriminatory capacity over BMD alone. Only a limited number of clinical risk factors were found associated with the risk of major OP fracture in peri-and early postmenopausal women. In this population, the FRAX tool, like other risk scores combining CRFs to either BMD or FRAX, had a poor sensitivity for fracture prediction and did not significantly improve the discriminatory value of hip BMD alone. ß

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“…The WHO collaborating center for metabolic bone diseases conducted several metaanalyses of data from large-scale prospective studies in various countries, including the OFELY study in France, (9,10) before developing a risk assessment tool-FRAX-from nine population-based studies-not including OFELY-for expressing absolute fracture risk in men and women in clinical practice. In France, the external validity of the model has been verified with the EPIDOS cohort, but the participants were only elderly and less representative of the French general population than the OFELY cohort.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, there has been interest in the development of algorithms that express absolute risk, or the probability of fracture within a given time period. (4)(5)(6)(7) The World Health Organization (WHO) Collaborating Center for Metabolic Bone Diseases conducted several metaanalyses of data from large-scale prospective studies in various countries to identify and quantify the risk of fracture associated with several clinical factors (personal history of fracture (8,9) or parental history of fracture, (10) body mass index, (11) smoking, (12) and glucocorticoid treatment (13) ) independent from BMD and age. These extensive studies have contributed to the development of a standardized methodaimed at use in clinical practice-for expressing absolute fracture risk in men and women.…”

Section: Introductionmentioning

confidence: 99%

The FRAX tool in French women: How well does it describe the real incidence of fracture in the OFELY cohort

Sornay‐Rendu

Munoz

Delmas

et al. 2010

Journal of Bone and Mineral Research

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The FRAX tool estimates an individual's fracture probability over 10 years from clinical risk factors with or without bone mineral density (BMD) measurement. The aim of our study was to compare the predicted fracture probabilities and the observed incidence of fracture in French women during a 10-year follow-up. The probabilities of fracture at four major sites (hip, clinical spine, shoulder, or wrist) and at the hip were calculated with the FRAX tool in 867 women aged 40 years and over from the Os des Femmes de Lyon (OFELY) cohort. The incidence of fracture was observed over 10 years. Thus 82 women sustained 95 incident major osteoporotic (OP) fractures including 17 fractures at the hip. In women aged at least 65 years (n ¼ 229), the 10-year predicted probabilities of fracture with BMD were 13% for major OP fractures and 5% for hip fractures, contrasting with 3.6% and 0.5% in women younger than 65 years ( p < .0001). The predicted probabilities of both major OP and hip fractures were significantly higher in women with osteoporosis (n ¼ 77, 18% and 10%) and osteopenia (n¼ 390, 6% and 2%) compared with women with normal BMD (n ¼ 208, 3% and <1%; p < .0001. The predicted probabilities of fracture were two and five times higher in women who sustained an incident major OP fracture and a hip fracture compared with women who did not ( p < .0001). Nevertheless, among women aged at least 65 years with low BMD values (T-score -1; n ¼ 199), the 10-year predicted probability of major OP fracture with BMD was 48% lower than the observed incidence of fractures ( p < .01). A 10-year probability of major OP fracture higher than 12% identified more women with incident fractures than did BMD in the osteoporotic range ( p < .05). In French women from the OFELY cohort, the observed incidence of fragility fractures over 10 years increased with age following a pattern similar to the predicted probabilities given by the FRAX tool. However, in women aged at least 65 years with low BMD, the observed incidence of fractures was substantially higher than the predicted probability. ß

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A family history of fracture and fracture risk: a meta-analysis

Cited by 353 publications

References 40 publications

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

Fracture risk prediction using BMD and clinical risk factors in early postmenopausal women: Sensitivity of the WHO FRAX tool

The FRAX tool in French women: How well does it describe the real incidence of fracture in the OFELY cohort

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