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The Difference between Hazard and Risk in the Relation between Bone Density and Fracture

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Abstract

The relation between fracture risk and bone density is frequently defined in terms of a relative hazard derived from the Cox proportional hazards model. The relative hazard is a multiplicative factor representing the rise in hazard for each standard deviation fall in bone mineral density, which has a typical value of about 1.5. It is not generally appreciated that this hazard may only be equated with absolute risk when risk is very low; at higher risk and over long periods, it is inappropriate to apply a multiplicative factor to absolute risk because risk has a range of 0-1 and cannot exceed unity. Here, we show how “hazard” can be converted to risk and how misleading the current practice of equating relative hazards with relative risks can be.

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Authors and Affiliations

  1. Institute of Medical and Veterinary Science, Frome Road, PO Box 14, Rundle Mall, Adelaide, 5000, South Australia, Australia

    B. E. Christopher Nordin

  2. Department of Medicine, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, South Australia, Australia

    B. E. Christopher Nordin

  3. Hanson Institute, Frome Road, Adelaide, 5000, South Australia, Australia

    B. E. Christopher Nordin

  4. Public Health Research Unit, Women’s and Children’s Hospital, King William Road, North Adelaide, 5006, South Australia, Australia

    Peter A. Baghurst

  5. Departments of Public Health and Paediatrics, University of Adelaide, Adelaide, 5005, South Australia, Australia

    Peter A. Baghurst

  6. School of Mathematical Sciences, University of Adelaide, Adelaide, 5005, South Australia, Australia

    Andrew Metcalfe

Authors
  1. B. E. Christopher Nordin
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  2. Peter A. Baghurst
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  3. Andrew Metcalfe
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Corresponding author

Correspondence to B. E. Christopher Nordin.

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Nordin, B.E.C., Baghurst, P.A. & Metcalfe, A. The Difference between Hazard and Risk in the Relation between Bone Density and Fracture. Calcif Tissue Int 80, 349–352 (2007). https://doi.org/10.1007/s00223-007-9022-4

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  • DOI: https://doi.org/10.1007/s00223-007-9022-4

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