Evaluate both fracture, mortality risks to inform osteoporosis treatment for older men
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Fracture and mortality risks for men aged 80 years or older have different profiles, and an assessment of both could help to inform osteoporosis drug treatment decisions, according to a speaker.
In an analysis of data from more than 3,000 older men, low bone mineral density and previous falls and fractures were associated with a higher predicted fracture risk, whereas men who were older and had comorbidities had a higher predicted mortality risk.
“We found that mortality risk could inform treatment decisions, since the balance of fracture and mortality risk varied quite substantially,” Lisa Langsetmo, PhD, MSc, a researcher in the department of epidemiology and public health at the University of Minnesota, told Healio. “Patient preferences are likely to play a role in decision-making.”
Langsetmo presented the findings during the American Society for Bone and Mineral Research Annual Meeting.
Langsetmo and colleagues analyzed data from 3,176 men aged 80 years or older with BMD measured as part of the Osteoporotic Fractures in Men study. Two Fine-Gray HR models were created, with the first model estimating 5-year fracture risk adjusted for competing mortality risk, and the second estimating mortality risk prior to a fracture adjusted for competing fracture risk. Age, total hip BMD, recent fractures, falls in the past year and multiple comorbidities were the independent variables used in both models. The cohort was divided into low-, medium- and high-risk tertiles for fracture and mortality risks. Mean predicted fracture and mortality risks were calculated for each of the nine subgroups.
Of the study cohort, 417 had incident fractures and 601 died prior to a facture. Lower total hip BMD (subdistribution HR = 1.74; 95% CI, 1.56-1.94), having a recent fracture (sHR = 1.79; 95% CI, 1.37-2.33) or having a fall in the past year (sHR = 1.32; 95% CI, 1.19-1.45) were associated with higher cumulative incidences of fracture. Higher cumulative incidences of mortality before a fracture were observed in men who were older (sHR = 1.64; 95% CI, 1.45-1.85) or had up to five comorbidities (sHR = 1.32; 95% CI, 1.25-1.39).
After grouping participants into tertiles, men with a low fracture risk of about 5% had a higher 5-year predicted mortality risk and should not be targeted for treatment, according to Langsetmo. Men with a medium fracture risk of about 10% saw their risk for fractures exceed mortality if they were in the low or medium mortality risk tertile, and providers should discuss possible treatment for fracture prevention. Men with a high fracture risk of about 20% and a low or medium mortality risk should be targeted for drug treatment to prevent fracture. For men with a medium or high fracture risk along with a high mortality risk, Langsetmo said, patient preference should be considered when discussing treatment due to mortality risk superseding the risk for a fracture.
“While many individuals in these groups will decline treatment, some will prioritize treatment,” Langsetmo said during the presentation. “Hence, patient preferences still matter.”
Langsetmo noted the models account for only some potential risk factors, and future studies could include a more comprehensive set of variables to further inform risk.
“We would also like to look at specific fracture outcomes and extend the results to women,” Langsetmo told Healio. “We have not looked at cost-effectiveness of therapy. We would also need to validate our model using other data.”
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Langsetmo L, et al. Abstract 1096. Presented at: ASBMR Annual Meeting; Oct. 1-4, 2021; San Diego (hybrid meeting).
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