Patients with Prior Fractures Have an Increased Risk of Future Fractures: A Summary of the Literature and Statistical Synthesis

Klotzbuecher, Carolyn M.; Ross, Philip D.; Landsman, Pamela B.; Abbott, Thomas A.; Berger, Marc L.

doi:10.1359/jbmr.2000.15.4.721

Cited by 1,715 publications

(878 citation statements)

References 52 publications

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“…It might be related to differences in the study populations, especially with regard to age and the type of incident fractures (hip versus other fractures) or the methods used. As already reported, (18)(19)(20) and not surprisingly, our study confirms that a history of a fragility fracture is a powerful predictor of future fracture independent of BMD. The multivariable-and BMD-adjusted risk of a major OP fracture was 2.3-to 2.5-fold higher in women who had reported a prior low-trauma fracture after the age of 45 years compared with women without a prior fracture history.…”

Section: Discussionsupporting

confidence: 91%

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

177

110

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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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Section: Discussionsupporting

confidence: 91%

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

177

110

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“…M any studies have shown increased fracture risk (1)(2)(3) and mortality (4)(5)(6)(7)(8) after clinical vertebral fracture. Even subjects with no clinical fracture and little pain but with vertebral deformity detected by X-ray showed slightly increased mortality.…”

Section: Introductionmentioning

confidence: 98%

Height loss starting in middle age predicts increased mortality in the elderly

Masunari

Fujiwara

Kasagi

et al. 2011

Journal of Bone and Mineral Research

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The purpose of this study was to determine the mortality risk among Japanese men and women with height loss starting in middle age, taking into account lifestyle and physical factors. A total of 2498 subjects (755 men and 1743 women) aged 47 to 91 years old underwent physical examinations during the period 1994 to 1995. Those individuals were followed for mortality status through 2003. Mortality risk was estimated using an age-stratified Cox proportional hazards model. In addition to sex, adjustment factors such as radiation dose, lifestyle, and physical factors measured at the baseline-including smoking status, alcohol intake, total cholesterol, blood pressure, and diagnosed diseases-were used for analysis of total mortality and mortality from each cause of death. There were a total of 302 all-cause deaths, 46 coronary heart disease and stroke deaths, 58 respiratory deaths including 45 pneumonia deaths, and 132 cancer deaths during the follow-up period. Participants were followed for 20,787 person-years after baseline. Prior history of vertebral deformity and hip fracture were not associated with mortality risk. However, more than 2 cm of height loss starting in middle age showed a significant association with all-cause mortality among the study participants (HR ¼ 1.76, 95% CI 1.31 to 2.38, p ¼ 0.0002), after adjustment was made for sex, attained age, atomic-bomb radiation exposure, and lifestyle and physical factors. Such height loss also was significantly associated with death due to coronary heart disease or stroke (HR ¼ 3.35, 95% CI 1.63 to 6.86, p ¼ 0.0010), as well as respiratory-disease death (HR ¼ 2.52, 95% CI 1.25 to 5.22, p ¼ 0.0130), but not cancer death. Continuous HL also was associated with all-cause mortality and CHD-or stroke-caused mortality. Association between height loss and mortality was still significant, even after excluding persons with vertebral deformity. Height loss of more than 2 cm starting in middle age was an independent risk factor for cardiovascular and respiratory-disease mortality among the elderly, even after adjusting for potential risk factors. ß

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“…In one systematic review, the risk factor for having a new vertebral fracture in women that have already fractured one vertebra was 4.4 times higher than those without fracture [1]. Moreover, prior vertebral fracture was also a good predictor for hip, forearm and any other non-vertebral fractures.…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis

2016

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. Health related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporosis International, 27(10), 2891 -2909 . DOI: 10.1007 Peer reviewed version Link to published version (if available): 10.1007/s00198-016-3648-x Link to publication record in Explore Bristol Research PDF-document This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Springer Verlag at doi:10.1007/s00198-016-3648-x. Please refer to any applicable terms of use of the publisher. University of Bristol -Explore Bristol Research General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms Purpose: This meta-analysis was conducted to identify if there are any differences between physical and/or mental health related quality of life (HRQoL) in older people with osteoporosis based on conventional T score definitions, and the presence or absence of vertebral fracture. Methods:A comprehensive search was undertaken using the databases of PubMed, Embase, Medline, Web of Science, and the "grey" literature from 1950 to the end of April 2015. Search terms for vertebral fracture (VF) included VF, osteoporotic fracture, fragility fracture, and spinal fracture. Quality of life was searched using the following terms: quality of life, health related quality of life, HRQoL, and QoL. Strict inclusion and exclusion criteria were used. The standardized mean difference (SMD) was calculated for each HRQoL domain by the difference in means between case and control groups divided by the pooled SD of participants.Results: 16 eligible studies were identified involving 3131 men and women. There was evidence of publication bias and heterogeneity. The meta-analysis showed worse physical (SMD= 0.53, 95% confidence interval (CI) 0.38 to 0.68; P <0.001) and mental (SMD= 0.19, 95%CI 0.05 to 0.33; P= 0.009) HRQoL in osteoporotic older people with vertebral fracture compared to those without fracture. Similar differences were observed for physical HRQoL in further analyses accounting for possible confounding effects of age. Sub-analysis to assess associations between number/severity of fractures and time since fracture were not possible due to small numbers of studies that accounted for age. Conclusion:Osteoporotic older people with vertebral fracture have worse physical HRQoL than osteoporotic older people without vertebral fracture, even after accounting for age differences. Keywords Osteoporosis Quality of lifeVertebral fracture Physical health Mental health Mini-abstractHealth related quality of life in osteoporotic patients with vertebral fracture is of increasing interest, but relevant studies have yielded debatable results. This systematic review and meta-analysis of 16 observational studies demonstrates a clear association between physical health status and presence of vertebral fra...

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Patients with Prior Fractures Have an Increased Risk of Future Fractures: A Summary of the Literature and Statistical Synthesis

Abstract: ABSTRACT

Cited by 1,715 publications

References 52 publications

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

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

Height loss starting in middle age predicts increased mortality in the elderly

Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis

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