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BMD, fracture history predict 25-year fracture risk in older women
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Fracture risk over 25 years can be estimated by both self-reported fracture history and a single femoral neck bone mineral density measurement in postmenopausal women, study data show.
Dennis M. Black, PhD, of the department of epidemiology and biostatistics at University of California, San Francisco, and colleagues evaluated data from the Study of Osteoporotic Fractures in 7,959 women (mean age, 73.4 years) to determine the relationship between BMD and fracture history to predict fracture risk over 20 to 25 years. Included women attended the second visit of the Study of Osteoporotic Fractures between 1988 and 1990; 38.4% reported a history of at least one nonvertebral fracture, and 2.3% reported a history of hip fracture after age 50 years.
Overall, 15.9% of participants experienced one or more hip fractures over 25 years of follow-up, and 43.7% had one or more nonvertebral fractures over 20 years of follow-up.
The 25-year cumulative incidences of both hip and nonvertebral fractures were higher among participants aged 80 years or older at baseline (22.6%) compared with those younger than 70 years (13.9%). Similarly, the 20-year incidence for nonvertebral fracture was higher among participants older than 80 years (50%) compared with those younger than 70 years (42.6%).
Long-term incidence of hip fracture was higher in participants in the lowest femoral neck BMD quartile (29.6%) compared with those in the highest quartile (7.6%). Long-term incidence of nonvertebral fracture was also higher in participants in the lowest femoral neck BMD quartile (59.7%) compared with those in the highest quartile (32.9%).
“We show that hip BMD is a remarkably persistent predictor of hip and nonvertebral fractures over 20 to 25 years and that self-reported history of any fracture also remains predictive over the very long term. By following this cohort of older women for so long, we show directly that lifetime risk of hip fracture in community-dwelling women over age 75 years is extremely high,” the researchers wrote. “These results strongly support the value of risk assessment and consideration of treatment even in the oldest, highest risk in women.” – by Amber Cox
Disclosures: Black reports he recieves grant support from Alexion and consulting fees from Amgen, Asahi-Kasei, Merck and Radius. Please see the full study for a list of all other authors’ relevant financial disclosures.
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