Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Kinnard, V.; Baleanu, Felicia; Iconaru, Laura; Moreau, Michel; Paesmans, Marianne; Body, Jean‐Jacques; Bergmann, Pierre

doi:10.1002/jbmr.3960

Cited by 7 publications

(4 citation statements)

References 8 publications

(13 reference statements)

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“…The third model is a nomogram for central fracture prediction. The relatively recent concept of central fractures ( 33 , 34 ) is justified by a higher morbidity and mortality after a rib or pelvis fracture (included in central fractures), compared with wrist fracture, which is part of MOFs ( 35-38 ). The incidence of these particular central fractures (rib, pelvis fractures) in our cohort was high, being the fifth and sixth in order of frequency, respectively, after the 4 classical MOFs.…”

Section: Discussionmentioning

confidence: 99%

Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study

Baleanu

Moreau

Charles

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Individualized fracture risk may help to select patients requiring a pharmacological treatment for osteoporosis. FRAX and the Garvan fracture risk calculators are the most used tools, though their external validation has shown significant differences in their risk prediction ability. Objective and Methods Using data from the FRISBEE study, a cohort of 3560 post-menopausal women aged 60-85 years, we aimed to construct original 5-year fracture risk prediction models using validated clinical risk factors (CRFs). Three models of competing risk analysis were developed to predict major osteoporotic fractures (MOFs), all fractures and central fractures (femoral neck, shoulder, clinical spine, pelvis, ribs, scapula, clavicle, sternum). Results Age, a history of fracture and hip or spine BMD were predictors common to the three models. Excessive alcohol intake, and the presence of comorbidities were specific additional CRFs for MOFs, a history of fall for all fractures and rheumatoid arthritis for central fractures. Our models predicted the fracture probability at 5-years with an acceptable accuracy (Brier scores ≤ 0.1) and had a good discrimination power (area under the receiver operating curve of 0.73 for MOFs and 0.72 for central fractures) when internally validated by bootstrap. Three simple nomograms, integrating significant CRFs and the mortality risk were constructed for different fracture sites. In conclusion, we derived three models predicting fractures with an acceptable accuracy, particularly for MOFs and central fractures. The models are based on a limited number of CRFs and we constructed nomograms for use in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study

Baleanu

Moreau

Charles

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Chronic hyponatremia increases the prevalence of vertebral fractures after low-energy trauma due to decreased bone quality [30]. Additional research suggests that individuals with central fractures demonstrate reduced bone mineral density, a poorer trabecular bone score, and a greater incidence of vertebral fractures in comparison with individuals with peripheral fractures [31]. A complex and varied relationship between fractures in different parts of the skeleton after a fall might be influenced by factors not only like osteoporosis or bone mineral density, but also the specific bones involved.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Hyponatremia and Hypokalemia on the Risk of Fractures in Various Anatomical Regions among Adult Trauma Patients: A Propensity Score-Matched Analysis

Hsu,

Rau,

Tsai

et al. 2024

Diagnostics

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Background: Hyponatremia and hypokalemia are common electrolyte imbalances in trauma patients and have been identified to be risk factors for a fall. In addition, hyponatremia was reported to be related to osteoporosis and fragility fractures, while the association between hypokalemia and osteoporosis has only been reported in rare case reports. This study investigated the impact of hyponatremia and hypokalemia on the incidence of fractures in various body regions of adult trauma patients, using the propensity score-matched patient cohort to reduce the influence of patients’ baseline characteristics. Methods: The study analyzed data from 11,173 hospitalized adult trauma patients treated from 1 January 1998, to 31 December 2022. The study included 1968 patients with hyponatremia and 9205 without, and 1986 with hypokalemia and 9187 without. Different 1:1 propensity score-matched cohorts were generated to create the 1903 pairings of patients with or without hyponatremia, 1977 pairings of patients with or without hypokalemia, and 380 pairing of patients with both hyponatremia and hypokalemia vs. normal control patients. Analysis was conducted on the incidence of fracture in various anatomic regions. Results: Hyponatremic patients had increased odds of thoracic vertebral fracture [odds ratio (95% confidence interval) 1.63 (1.10–2.42), p = 0.014], pelvic fracture [2.29 (1.12–4.67), p = 0.019], and femoral fracture [1.28 (1.13–1.45), p < 0.001] but decreased odds of radial and patella fractures. Hypokalemic patients showed no significant differences in fracture risk except for a decreased likelihood of radial fractures. The patients with both hyponatremia and hypokalemia showed a decreased likelihood of radial fractures and patella fractures. Conclusion: Hyponatremia may have a greater impact on the occurrence of bone fractures than hypokalemia in trauma patients who have suffered a fall. Electrolyte abnormalities should be taken into account while assessing the risk of fractures in trauma patients.

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“…Fractures of the skull, face, fingers, toes, and traumatic or pathological fractures, ie, caused by metastatic cancer, were not considered in this report. ( 18,19 )…”

Section: Methodsmentioning

confidence: 99%

“…Fractures of the skull, face, fingers, toes, and traumatic or pathological fractures, ie, caused by metastatic cancer, were not considered in this report. (18,19) The occurrence of fractures that were incident nontraumatic or low-traumatic (falls from standing height or less) was systematically registered. To be considered, any fracture reported by the study participants had to be validated by obtaining written radiological and/or surgical reports.…”

Section: Methodsmentioning

confidence: 99%

Prediction of an Imminent Fracture After an Index Fracture – Models Derived From the Frisbee Cohort

Iconaru

Charles

Baleanu

et al. 2020

Journal of Bone and Mineral Research

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Patients who sustain a fracture are at greatest risk of recurrent fracture during the next 2 years. We propose three models to identify subjects most at risk of an imminent fracture, according to fracture site (any fracture, major osteoporotic fracture [MOF] or central). They were constructed using data of the prospective Frisbee cohort, which includes 3560 postmenopausal women aged 60 to 85 years who were followed for at least 5 years. A total of 881 subjects had a first incident validated fragility fracture before December 2018. Among these, we validated 130 imminent fractures occurring within the next 2 years; 79 were MOFs, and 88 were central fractures. Clinical risk factors were re-evaluated at the time of the index fracture. Fine and Gray proportional hazard models were derived separately for each group of fractures. The following risk factors were significantly associated with the risk of any imminent fracture: total hip bone mineral density (BMD) (p < 0.001), a fall history (p < 0.001), and comorbidities (p = 0.03). Age (p = 0.05 and p = 0.03, respectively) and a central fracture as the index fracture (p = 0.04 and p = 0.005, respectively) were additional predictors of MOFs and central fractures. The three prediction models are presented as nomograms. The calibration curves and the Brier scores based on bootstrap resampling showed calibration scores of 0.089 for MOF, 0.094 for central fractures, and 0.132 for any fractures. The predictive accuracy of the models expressed as area under the receiver operating characteristic (AUROC) curve (AUC) were 0.74 for central fractures, 0.72 for MOFs, and 0.66 for all fractures, respectively. These AUCs compare well with those of FRAX and Garvan to predict the 5-or 10-year fracture probability. In summary, five predictors (BMD, age, comorbidities, falls, and central fracture as the incident fracture) allow the calculation with a reasonable accuracy of the imminent risk of fracture at different sites (MOF, central fracture, and any fracture) after a recent sentinel fracture.

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Postfracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Cited by 7 publications

References 8 publications

Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study

Fragility Fractures in Postmenopausal Women: Development of 5-Year Prediction Models Using the FRISBEE Study

The Influence of Hyponatremia and Hypokalemia on the Risk of Fractures in Various Anatomical Regions among Adult Trauma Patients: A Propensity Score-Matched Analysis

Prediction of an Imminent Fracture After an Index Fracture – Models Derived From the Frisbee Cohort

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