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Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos)

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Abstract

Summary

Using data from the Canadian Multicentre Osteoporosis Study, several risk factors predictive of imminent (2-year) risk of low-trauma non-vertebral fracture among high-risk women were identified, including history of falls, history of low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to targeting this population for therapy.

Purpose

Fracture risk assessment has focused on a long-term horizon and populations with a broad risk range. For elderly women with osteoporosis or low bone mass, or a history of fragility fractures (“high-risk women”), risk prediction over a shorter horizon may have greater clinical relevance.

Methods

A repeated-observations design and data from the Canadian Multicentre Osteoporosis Study were employed. Study population comprised women aged ≥ 65 years with T score (total hip, femoral neck, spine) ≤ − 1.0 or prior fracture. Hazard ratios (HR) for predictors of low-trauma non-vertebral fracture during 2-year follow-up were estimated using multivariable shared frailty model.

Results

The study population included 3228 women who contributed 5004 observations; 4.8% experienced low-trauma non-vertebral fracture during the 2-year follow-up. In bivariate analyses, important risk factors included age, back pain, history of falls, history of low-trauma fracture, physical function, health status, and total hip T score. In multivariable analyses, only four independent predictors were identified: falls in past 12 months (≥ 2 falls: HR = 1.9; 1 fall: HR = 1.5), low-trauma fracture in past 12 months (≥ 1 fracture: HR = 1.7), SF-36 physical component summary score (≤ 42.0: HR = 1.6), and total hip T score (≤ − 3.5: HR = 3.7; > − 3.5 to ≤ − 2.5: HR = 2.5; > − 2.5 to ≤ − 1: HR = 1.3).

Conclusions

Imminent risk of low-trauma non-vertebral fracture is elevated among high-risk women with a history of falls or low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to identifying and targeting this population for therapy.

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Acknowledgments

Funding for this research was provided by Amgen Inc. and UCB Pharma. The Canadian Multicentre Osteoporosis Study was funded by the Canadian Institutes of Health Research (CIHR); Merck Frosst Canada Ltd.; Eli Lilly Canada Inc.; Novartis Pharmaceuticals Inc.; The Alliance: Sanofi-Aventis & Procter and Gamble Pharmaceuticals Canada Inc.; Servier Canada Inc.; Amgen Canada Inc.; The Dairy Farmers of Canada; and The Arthritis Society.

Funding

Funding for this research was provided by Amgen Inc. to Policy Analysis Inc. (PAI).

Author information

Authors and Affiliations

  1. McMaster University, Hamilton, ON, Canada

    Jonathan D. Adachi, George Ioannidis & Alexandra Papaioannou

  2. Research Institute of the McGill University Health Centre, Montreal, QC, Canada

    Claudie Berger

  3. Amgen Inc., Thousand Oaks, CA, USA

    Rich Barron

  4. Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA

    Derek Weycker, Erinda Shyta & Amanda Silvia

  5. Queen’s University, Kingston, ON, Canada

    Tassos P. Anastassiades & Tanveer Towheed

  6. University of Victoria, Victoria, BC, Canada

    K. Shawn Davison

  7. Cumming School of Medicine, University of Calgary, Calgary, AL, Canada

    David A. Hanley

  8. University of Alberta, Edmonton, AB, Canada

    Stuart A. Jackson

  9. University of Toronto, Toronto, ON, Canada

    Robert G. Josse

  10. Dalhousie University, Halifax, NS, Canada

    Stephanie M. Kaiser

  11. Memorial University of Newfoundland, St. John’s, NL, Canada

    Christopher S. Kovacs

  12. University of Manitoba, Winnipeg, MB, Canada

    William D. Leslie

  13. McGill University, Montreal, QC, Canada

    Suzanne N. Morin & David Goltzman

  14. University of British Columbia, Vancouver, BC, Canada

    Jerilynn C. Prior

Authors
  1. Jonathan D. Adachi
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  2. Claudie Berger
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  3. Rich Barron
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Contributions

Authorship was designated based on the guidelines promulgated by the International Committee of Medical Journal Editors (2004). All persons who meet criteria for authorship are listed as authors on the title page. The contribution of each of these persons to this study is as follows: (1) conception and design (all authors), acquisition of data (all authors except Barron, Shyta, Silvia, Weycker), and analysis or interpretation of data (all authors) and (2) preparation of manuscript (Barron, Shyta, Silvia, Weycker) and critical review of manuscript (all authors). The study sponsor reviewed the study protocol and study manuscript; data management, processing, and analyses were conducted by PAI, and all final analytic decisions were made by study investigators. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Derek Weycker.

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Conflicts of interest

Rich Barron was employed by Amgen Inc. during the conduct of this study and owns stock in Amgen Inc. Derek Weycker and Amanda Silvia are employed by PAI; Erinda Shyta was employed by PAI during the conduct of this study. Jonathan D. Adachi has grants and personal fees with Amgen Inc. and personal fees with Eli Lilly. K. Shawn Davison has speaker honoraria with Amgen Inc. David A. Hanley has a research grant and speaker honoraria with Amgen Inc. Robert G. Josse has consultancy fees and a speaking honoraria with Amgen Inc. and Merck. Stephanie M. Kaiser has consultancy fees and speaking honoraria with Amgen Inc. Christopher S. Kovacs has an honorarium with Amgen Inc. Suzanne N. Morin has research grants with Amgen Inc. and Merck. Tanveer Towheed has an honorarium and speaker fees with Amgen Inc. Tassos P. Anastassiades, Claudie Berger, David Goltzman, George Ioannidis, Stuart A. Jackson, William D. Leslie, Alexandra Papaioannou, and Jerilynn C. Prior have no conflicts of interest for this work.

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Adachi, J.D., Berger, C., Barron, R. et al. Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 14, 53 (2019). https://doi.org/10.1007/s11657-019-0598-x

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