Osteoporosis International

, Volume 16, Issue 5, pp 568–578

Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos)

  • Alexandra Papaioannou
  • Lawrence Joseph
  • George Ioannidis
  • Claudie Berger
  • Tassos Anastassiades
  • Jacques P. Brown
  • David A. Hanley
  • Wilma Hopman
  • Robert G. Josse
  • Susan Kirkland
  • Timothy M. Murray
  • Wojciech P. Olszynski
  • Laura Pickard
  • Jerilynn C. Prior
  • Kerry Siminoski
  • Jonathan D. Adachi
Original Article

DOI: 10.1007/s00198-004-1735-x

Cite this article as:
Papaioannou, A., Joseph, L., Ioannidis, G. et al. Osteoporos Int (2005) 16: 568. doi:10.1007/s00198-004-1735-x

Abstract

Utilizing data from the Canadian Multicentre Osteoporosis Study (CaMos), we examined the association between potential risk factors and incident vertebral and nonvertebral fractures. A total of 5,143 postmenopausal women were enrolled. Information collected during the study included data from the CaMos baseline and annually mailed fracture questionnaires, the Short Form 36 (SF-36), the Health Utilities Index, and physical measurements. Participants were followed for 3 years. Postmenopausal women were classified into four groups according to their incident fracture status since baseline: those without a new fracture; those with a new clinically recognized vertebral fracture; those with an incident nonvertebral fracture at the wrist, hip, humerus, pelvis, or ribs (main nonvertebral fracture group); and those with any new nonvertebral fracture (any-nonvertebral-fracture group). We performed multivariate Cox proportional hazard analysis using all possible risk factors to determine the association between risk factors and the time to the first minimal trauma fracture. Best predictive models were also determined using variables that were included in the full models. The Bayesian information criterion was used for model selection. For all analyses, relative risks and associated 95% confidence intervals were calculated. During the follow-up period, 34, 163, and 280 women developed a vertebral, a main nonvertebral, or any nonvertebral fracture, respectively. The best predictive models indicated that a five point lower quality of life as measured by the SF-36 physical component summary score was associated with relative risks of 1.21 (95% CI, 1.02 to 1.44), 1.17 (95% CI, 1.07 to 1.28), and 1.19 (95% CI, 1.11 to 1.27) for incident vertebral, main nonvertebral, and all nonvertebral fractures, respectively. In addition, for a one standard deviation (SD=0.12) lower femoral neck BMD, the relative risks for incident vertebral, main nonvertebral, and any nonvertebral fractures increased by 2.73 (95% CI, 1.74 to 4.28), 1.39 (95% CI, 1.06 to 1.82), and 1.34 (95% CI, 1.09 to 1.65), respectively. Furthermore, various anthropometric measures, disease conditions, and medications are associated with a new fracture. Identifying postmenopausal women at risk is important given that fracture prevention therapies are now available.

Keywords

Nonvertebral fractures Postmenopausal women Prospective Risk factors Vertebral fractures 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • Alexandra Papaioannou
    • 1
    • 13
  • Lawrence Joseph
    • 2
  • George Ioannidis
    • 1
  • Claudie Berger
    • 3
  • Tassos Anastassiades
    • 4
  • Jacques P. Brown
    • 5
  • David A. Hanley
    • 6
  • Wilma Hopman
    • 7
  • Robert G. Josse
    • 8
  • Susan Kirkland
    • 9
  • Timothy M. Murray
    • 8
  • Wojciech P. Olszynski
    • 10
  • Laura Pickard
    • 1
  • Jerilynn C. Prior
    • 11
  • Kerry Siminoski
    • 12
  • Jonathan D. Adachi
    • 1
  1. 1.Department of Medicine, St. Joseph’s HospitalMcMaster UniversityHamiltonCanada
  2. 2.Department of Epidemiology and BiostatisticsMcGill UniversityMontrealCanada
  3. 3.CaMos Analysis CentreMcGill UniversityMontrealCanada
  4. 4.Division of Rheumatology, Department of Medicine; Department of Community Health and EpidemiologyQueen’s UniversityKingstonCanada
  5. 5.Department of MedicineLaval UniversitySte-FoyCanada
  6. 6.Department of MedicineUniversity of CalgaryCalgaryCanada
  7. 7.Clinical Research Centre, Kingston General Hospital and the Department of Community Health and EpidemiologyQueen’s UniversityKingstonCanada
  8. 8.Department of Medicine, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  9. 9.Department of Community Health and EpidemiologyDalhousie UniversityHalifaxCanada
  10. 10.Department of MedicineUniversity of SaskatchewanSaskatoonCanada
  11. 11.Department of Medicine/ EndocrinologyUniversity of British ColumbiaVancouverCanada
  12. 12.Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Internal MedicineUniversity of AlbertaEdmontonCanada
  13. 13.Chedoke Division, Geriatric MedicineHamilton Health Sciences CorporationHamiltonCanada

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