Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)
Center for Outcomes Research
Osteoporosis; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Fractures, Bone
Health Services Research | Musculoskeletal Diseases
INTRODUCTION: Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX.
MATERIALS AND METHODS: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates.
RESULTS: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease.
CONCLUSION: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.
DOI of Published Version
Bone. 2012 Jun;50(6):1288-93. Epub 2012 Mar 9. Link to article on publisher's site
Dennison, Elaine M.; Compston, Juliet E.; Flahive, Julie; Siris, Ethel S.; Gehlbach, Stephen H.; Jonathan D.; Boonen, Steven; Chapurlat, Roland D.; Diez-Perez, Adolfo; Anderson, Frederick A. Jr.; Hooven, Frederick H.; LaCroix, Andrea Z.; Lindsay, Robert; Netelenbos, J. Coen; Pfeilschifter, Johannes; Rossini, Maurizio; Roux, Christian; Saag, Kenneth G.; Sambrook, Phillip N.; Silverman, Stuart; Watts, Nelson B.; Greenspan, Susan L.; Premaor, Melissa; and Cooper, Cyrus, "Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)" (2012). GLOW Publications. 6.