Empirically based composite fracture prediction model from the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW)
Center for Outcomes Research
Medical Subject Headings
Age Factors; Aged; Aged, 80 and over; Cohort Studies; Female; Fractures, Bone; Humans; Longitudinal Studies; Middle Aged; *Models, Statistical; Osteoporosis, Postmenopausal; Prognosis; Risk Factors
Endocrinology, Diabetes, and Metabolism | Health Services Research | Musculoskeletal Diseases | Women's Health
CONTEXT: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired.
OBJECTIVE: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles.
DESIGN: This was a prospective, observational cohort study.
SETTING: The study was conducted at primary care practices in 10 countries.
PATIENTS: Women aged 55 years or older participated in the study.
INTERVENTION: Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures.
MAIN OUTCOME MEASURE: The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age.
RESULTS: Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase.
CONCLUSIONS: After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model.
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Citation: J Clin Endocrinol Metab. 2014 Mar;99(3):817-26. doi: 10.1210/jc.2013-3468. Link to article on publisher's site.
FitzGerald, Gordon; Hosmer, David W. Jr.; Anderson, Frederick A. Jr.; Hooven, Fred H.; and Gehlbach, Stephen H., "Empirically based composite fracture prediction model from the Global Longitudinal Study of Osteoporosis in Postmenopausal Women (GLOW)" (2014). GLOW Publications. 21.