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Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis

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Abstract

Aim: To determine the longitudinal progression of fractures through a population of osteoporotic women with no existing vertebral fractures. Methods: The probability of having one or more vertebral fractures in the next year given a current status of 0–13 existing vertebral fractures was estimated using data from control patients of an osteoporosis clinical trial program. Fracture probabilities were used to form a transition matrix that models the change in fracture state from one year to the next. A Markov model was used to show the distribution of fracture prevalence over time for a population of women with osteoporosis but, initially, with no existing vertebral fractures. Results: An osteoporotic woman without existing vertebral fractures has a 7.7% chance (95% CI, 5.8% to 9.9%) of having a vertebral fracture within 1 year. After 5 years, 33% (95% CI, 25% to 41%) will have developed vertebral fractures, of which 11% (95% CI, 8% to 16%) will have ≥2 fractures. After 10 years, 55% (95% CI, 44% to 65%) will have developed vertebral fractures, of which 29% (95% CI, 22% 37%) will have ≥2 fractures. Each 1% absolute reduction in the annual first-fracture risk corresponds to an approximate 4% reduction in the 5-year fracture incidence. Therefore, reducing the risk of first fracture from 8% to 2% reduces the 5-year fracture incidence from ~34% to ~10%. Conclusions: Fracture prevalence rapidly increases over time in a population of osteoporotic women despite treatment with calcium and vitamin D supplements. Identifying and treating patients at risk of fracture, but who have not yet sustained a fracture, will substantially reduce the long-term burden of osteoporosis.

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Acknowledgements

Funding: financial support was obtained from Procter and Gamble and from Aventis.

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Authors and Affiliations

  1. Helen Hayes Hospital, Route 9 W, West Haverstraw, NY 10993, USA

    Robert Lindsay

  2. Procter and Gamble, Staines, TW18 3AZ, UK

    Simon Pack

  3. Department of Biometrics and Statistical Sciences, Procter and Gamble, Mason, Ohio, USA

    Zhengqing Li

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  1. Robert Lindsay
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  2. Simon Pack
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Correspondence to Robert Lindsay.

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Lindsay, R., Pack, S. & Li, Z. Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int 16, 306–312 (2005). https://doi.org/10.1007/s00198-004-1691-5

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  • DOI: https://doi.org/10.1007/s00198-004-1691-5

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