Long-Term Fracture Risk May Be Estimated By Simple Assessments

Bone mineral density (BMD) and fracture history assessments can predict the risk of osteoporotic fracture in postmenopausal women over a period of 20 to 25 years, according to a recent study.

It is well known that BMD and other risk factors can be used to predict fracture risk over a period of 5 to 10 years. However, it is unknown whether assessing the risk factors can predict risk over a longer period of time.
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The researchers used data from the Study of Osteoporotic Fractures (SOF), which evaluated BMD and associated risk factors in 7959 women aged 67 years or older from 1988 to 1990. Follow-up lasted 25 years for fractures, and 20 years for nonvertebral fractures.

Age-adjusted proportional hazards models were used to analyze the relationships between a single baseline assessment of femoral neck BMD, fracture history and age, and fracture incidence over 20 to 25 years.

Results showed a 17.9% cumulative incidence of hip fracture over 25 years, while the incidence of nonvertebral fracture was 46.2% over 20 years. Hip fracture was most common among women aged 80 years or older (22.6% vs 13.9% among women aged younger than 70 years).

The researchers found that a single femoral neck BMD measurement was able to strongly predict the long-term risk of hip fracture up to 25 years, with risk being 29.6% in the lowest BMD quartile compared with 7.6% in the highest quartile. Femoral neck BMD predicted hip fracture for 20 to 25 years with little degradation over time.

Lifetime risk of hip fracture was similar regardless of participants’ age, approximately 30%. The researchers noted that history of hip fracture predicted hip fractures only slightly better than history of nonvertebral fracture, and that fracture history remained strongly predictive up to 25 years.

“We conclude that a single BMD and fracture history assessment can predict fracture risk over 20 to 25 years,” the researchers wrote. “Long-term risk of hip fracture remains extremely high in the oldest age groups, supporting risk assessment and consideration of treatment even in the oldest, highest-risk women.”

—Christina Vogt

Reference:

Black DM, Cauley JA, Wagman R, et al. The ability of a single BMD and fracture history assessment to predict fracture over 25 years in postmenopausal women: the study of osteoporotic fractures [Published online July 18, 2017]. J Bone Miner Res. doi:10.1002/jbmr.3194.