This article is more than 5 years old. Information may no longer be current.
NHANES data: FRAX estimates reveal hip, major osteoporotic fracture probability among middle-aged, older US adults
Fracture risk assessment tool, or FRAX, estimates from the 2013-2014 National Health and Nutrition Examination Survey show that mean, 10-year hip and major osteoporotic fracture probabilities were 0.5% and 5.3%, respectively, among adults aged at least 40 years, according to a report released by the National Center for Health Statistics.
Among adults aged at least 50 years, 10-year fracture probabilities for hip and major osteoporotic fracture rose to 0.9% and 7.4%, respectively, with the risk growing with clinical risk factors, such as previous fracture, according to the data.
“This report provides the first nationally representative estimates of the absolute probability of suffering a hip or major osteoporotic fracture in the next 10 years among middle-aged and older adults in the United States using the FRAX model,” Anne C. Looker, PhD, of the National Center for Health Statistics, and colleagues wrote. “These FRAX-based findings expand the understanding of skeletal health in the United States by providing a more global evaluation of fracture risk than can be obtained from estimates based on [bone mineral density] alone.”
Looker and colleagues analyzed data from 3,127 adults aged at least 40 years participating in the 2013-2014 NHANES who had validated femoral neck BMD measurements, height and weight data (mean age, 57 years; mean BMI, 29 kg/m²; mean femoral neck BMD, 0.779 g/cm2). Researchers calculated 10-year probability scores for hip and major osteoporotic fracture (involving hip, spine, proximal humerus or distal forearm) using FRAX version 3.05 for the United States. Self-reported risk factors included in analysis were fracture history (including parental history of hip fracture), glucocorticoid use, rheumatoid arthritis, smoking status and alcohol intake. Among adults aged at least 50 years, elevated probabilities were defined as 3% or greater for hip fracture and 20% or greater for major osteoporotic fracture.
Most adults (59%) reported having at least one clinical risk factor; 35% reported previous fracture, 19% reported drinking alcohol three or more times per day and 18% reported smoking.
Mean skew-adjusted fracture probabilities were 0.5% for hip fracture and 5.3% for major osteoporotic fracture among adults aged at least 40 years; 0.9% and 7.4%, respectively, among adults aged at least 50 years, according to the researchers. Overall, approximately 19% of adults aged at least 50 years had a hip fracture probability that was 3% or higher; 8% had a major osteoporotic fracture probability that was 20% or higher.
After adjusting for age, women had a two- to sevenfold higher 10-year hip and major osteoporotic fracture probability vs. men (P < .001), with unadjusted prevalence increasing with age (P < .001). In addition, age-adjusted 10-year fracture probabilities were higher in white adults vs. other racial groups (P < .001).
Between 95% and 97% of adults aged at least 50 years with an elevated probability of either fracture type had poor status at the femoral neck, the researchers noted; among adults with an elevated hip fracture probability, 67% had low bone mass, and 30% had osteoporosis at the femur neck. Among those with elevated major osteoporotic fracture probability, 53% had low bone mass and 42% had osteoporosis at the femur neck.
“The remaining 3% to 5% with elevated fracture probability scores and normal femur neck status may have met one of the other conditions outlined in the [National Osteoporosis Foundation] criteria (eg, poor lumber spine status or a previous hip or spine fracture), but this was not examined in the present study,” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.