Evaluation of easily measured risk factors in the prediction of osteoporotic fractures.

ABSTRACT

BACKGROUND: Fracture represents the single most important clinical event in patients with osteoporosis, yet remains under-predicted. As few premonitory symptoms for fracture exist, it is of critical importance that physicians effectively and efficiently identify individuals at increased fracture risk. METHODS: Of 3426 postmenopausal women in CANDOO, 40, 158, 99, and 64 women developed a new hip, vertebral, wrist or rib fracture, respectively. Seven easily measured risk factors predictive of fracture in research trials were examined in clinical practice including age (< 65, 65-69, 70-74, 75-79, 80+ years), rising from a chair with arms (yes, no), weight (< 57, > or = 57 kg), maternal history of hip fracture (yes, no), prior fracture after age 50 (yes, no), hip T-score (> -1, -1 to > -2.5, < or = -2.5), and current smoking status (yes, no). Multivariable logistic regression analysis was conducted. RESULTS: The inability to rise from a chair without the use of arms (3.58; 95% CI 1.17, 10.93) was the most significant risk factor for new hip fracture. Notable risk factors for predicting new vertebral fractures were low body weight (1.57; 95% CI 1.04, 2.37), current smoking (1.95; 95% CI 1.20, 3.18) and age between 75-79 years (1.96; 95% CI 1.10, 3.51). New wrist fractures were significantly identified by low body weight (1.71, 95% CI 1.01, 2.90) and prior fracture after 50 years (1.96; 95% CI 1.19, 3.22). Predictors of new rib fractures include a maternal history of a hip fracture (2.89; 95% CI 1.04, 8.08) and a prior fracture after 50 years (2.16; 95% CI 1.20, 3.87). CONCLUSION: This study has shown that there exists a variety of predictors of future fracture, besides BMD, that can be easily assessed by a physician. The significance of each variable depends on the site of incident fracture. Of greatest interest is that an inability to rise from a chair is perhaps the most readily identifiable significant risk factor for hip fracture and can be easily incorporated into routine clinical practice.