Residual Lifetime Risk of Fractures in Women and Men

Abstract

In a sample of 1358 women and 858 men, ≥60 yr of age who have been followed-up for up to 15 yr, it was estimated that the mortality-adjusted residual lifetime risk of fracture was 44% for women and 25% for men. Among those with BMD T-scores ≤ −2.5, the risks increased to 65% in women and 42% in men.Introduction: Risk assessment of osteoporotic fracture is shifting from relative risk to an absolute risk approach. Whereas BMD is a primary predictor of fracture risk, there has been no estimate of mortality-adjusted lifetime risk of fracture by BMD level. The aim of the study was to estimate the residual lifetime risk of fracture (RLRF) in elderly men and women. Materials and Methods: Data from 1358 women and 858 men Ն60 yr of age as of 1989 of white background from the Dubbo Osteoporosis Epidemiology Study were analyzed. The participants have been followed for up to 15 yr. During the follow-up period, incidence of low-trauma, nonpathological fractures, confirmed by X-ray and personal interview, were recorded. Incidence of mortality was also recorded. BMD at the femoral neck was measured by DXA (GE-LUNAR) at baseline. Residual lifetime risk of fracture from the age of 60 was estimated by the survival analysis taking into account the competing risk of death. Results: After adjusting for competing risk of death, the RLRF for women and men from age 60 was 44% (95% CI, 40-48) and 25% (95% CI, 19-31), respectively. For individuals with osteoporosis (BMD T-scores Յ −2.5), the mortality-adjusted lifetime risk of any fracture was 65% (95% CI, 58-73) for women and 42% (95% CI, 24-71) for men. For the entire cohort, the lifetime risk of hip fracture was 8.5% (95% CI, 6-11%) for women and 4% (95% CI, 1.3-5.4%) for men; risk of symptomatic vertebral fracture was 18% (95% CI, 15-21%) for women and 11% (95% CI, 7-14%) for men. Conclusions: These estimates provide a means to communicate the absolute risk of fracture to an individual patient and can help promote the identification and targeting of high-risk individuals for intervention.

Gender Differences in Osteoporosis and Fractures

“…The lifetime risk of fracture for a 60-year-old woman is approximately 44%, nearly double the risk of 25% for a man of the same age [28]. In 2005, there were approximately 1.45 million fractures in women older than 50 years in the United States, compared with 594,000 fractures in men of the same age [4].…”

“…Vertebral fractures are not as well studied as nonspine fractures, partially because not all of these fractures come to clinical attention. Despite limited data, it appears older men and women have a similar prevalence of vertebral fracture at age 65 years, but the incidence of new vertebral fracture in older women is almost double compared to older men [16,28].…”

Genetic profiling and individualized prognosis of fracture

“…Approximately 44% of women and 25% of men aged 50 years will sustain a fracture during their remaining lifetime. (1) Individuals with a preexisting fracture are at increased risk of subsequent fracture (2) and death. (3) Pharmacologic treatment of individuals with a preexisting fracture can reduce further fracture (4) and mortality risk.…”

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

“…We selected the heteroscedastic random error option and specified the standard error at each time period. 3 Log transformation was selected in order to calculate annual percent change (APC), which was the average rate of change in a fracture rate per year during the study period. APCs are scale invariant and useful for comparing across populations or subgroups with very different rates.…”

“…The risk of a first [3] and subsequent [4][5][6] osteoporotic fracture increases with age. Among those aged 80 years and older, the 5-year risk of fracture has been estimated as 17 % in women and 11 % in men [3]. The consequences of fractures, particularly hip and spine, can be devastating and may be most severe in the elderly [4].…”