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Acknowledgment of comorbidities could improve fracture-prediction algorithms
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An increased awareness of comorbidities and their impact upon fracture risk may help improve upon fracture-prediction algorithms, according to a study published in Bone.
The researchers used the multinational Global Longitudinal Study of Osteoporosis in Women (GLOW) to assess comorbidities’ effect on fracture risk, with baseline questionnaires and occasional follow-up interviews to determine any incidence of clinical fracture and comorbidities. A comorbidity index was compiled, and the impact of this index’s addition to FRAX risk factors was assessed.
According to the study abstract, 3,224 (6.1%) of 52,960 women in the GLOW study developed fractures during a 2-year period. Parkinson’s disease and multiple sclerosis indicate a higher risk of fracture than other comorbidities, the researchers noted. With the exception of hypertension, celiac disease, cancer and high cholesterol, all recorded comorbidities in the GLOW study were significantly associated with fracture risk. Heart disease, osteoarthritis and chronic obstructive pulmonary disease were major predictors of fracture.
Using a fracture prediction algorithm and adding a comorbidity index resulted in an improvement of the fracture prediction model, the authors concluded in the abstract.
Perspective
Back to TopLisa K. Cannada, MD
The GLOW study had a large number of women followed and noted a 6% fracture risk at 2 years. However, the authors found that any comorbidity, with little exception, contributed to increased fracture risk. I found it interesting that in the conclusion, the authors stated Parkinson's disease (PD) — which is twice as common in males —was cited to increase fracture risk. The risk can be increased in PD due to balance issues, especially as the disease progress. Likewise, an increased fracture risk in multiple sclerosis (MS) could be due to symptoms of the disease, which can affect eyesight. A patient with cancer would be expected to have an increased fracture risk, but this was not found!
The authors would be better served reporting how risk factors in relatively healthy women affect fracture risk and presenting an algorithm with fracture risk and how it increases with 3, 4 or 5 comorbidities for example (perhaps in the form of a clinical prediction model). Some findings in GLOW, such as increased risk with osteoarthritis (OA) is opposite of what is reported when completing the FRAX form. Overall, the article is on a hot topic, but difficult to interpret out true increased risk factors, not due to underlying, less common diseases.
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Dennison E. Bone. 2012. doi:10.1016/j.bone.2012.02.639
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