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Epidemiology of fracture risk in the Women’s Health Initiative

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Osteoporosis is one of the most disabling consequences of aging in women. Strategies that permit earlier identification of women at risk for fracture are needed. The Women’s Health Initiative has extended our knowledge of clinical risk factors and biomarkers of fracture risk in postmenopausal women. Based upon 11 clinically available risk factors (age, race/ethnicity, self-reported health, weight, height, physical activity, parental hip fracture, fracture history after age 54, current smoking, corticosteroid use, and history of treated diabetes), an algorithm has been developed to predict 5-year hip fracture risk. Biomarkers including low vitamin D or bioavailable testosterone and/or high cystatin C or sex hormone-binding globulin also predict risk for hip fracture independent of clinical risk factors. To address the growing incidence of fractures in minority women, clinical risk factors for fracture have been identified. These data demonstrate that we can better identify women, irrespective of race or ethnicity, at risk for fracture.

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References and Recommended Reading

  1. Burge R, Dawson-Highes B, Solomon DH, et al.: Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2006, 21:465–475.

    Google Scholar 

  2. Magaziner J, Hawkes W, Hebel JR, et al.: Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000, 55:M498–M507.

    PubMed  CAS  Google Scholar 

  3. VanStaa TP, Dennison EM, Leufkens HE, Cooper C: Epidemiology of fractures in England and Wales. Bone 2001, 29:517–522.

    Article  CAS  Google Scholar 

  4. Sambrook P, Cooper C: Osteoporosis. Lancet 2006, 367:2010–2018.

    Article  PubMed  CAS  Google Scholar 

  5. Marks R, Allegrante JP, Mackenzie CR, Lane JM: Hip fractures among the elderly: causes, consequences and control. Aging Res Rev 2003, 2:57–93.

    Article  Google Scholar 

  6. Heaney RP: Remodeling and skeletal fragility. Osteoporos Int 2003, 14(Suppl):S12–S15.

    Google Scholar 

  7. Johnell O, Kanis JA, Oden A, et al.: Predictive value of bone mineral density for hip and other fractures. J Bone Miner Res 2005, 20:1185–1194.

    Article  PubMed  Google Scholar 

  8. Wainwright SA, Phipps KR, Stone JV, et al.: A large proportion of fractures in postmenopausal women occur with baseline bone mineral density T-score >= 2.5 [abstract]. J Bone Miner Res 2001, 16:S155.

    Google Scholar 

  9. Henry MJ, Pasco JA, Seeman E, et al.: Assessment of fracture risk: value of random population-based samples: the Geelong Osteoporosis Study. J Clin Densitom 2001, 4:283–289.

    Article  PubMed  CAS  Google Scholar 

  10. Kanis JA, Johnell O, Oden A, et al.: Risk of hip fracture according to World Health Organization criteria for osteopenia and osteoporosis. Bone 2000, 27:585–590.

    Article  PubMed  CAS  Google Scholar 

  11. Hui SL, Slemenda CW, Johnston CC: Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988, 81:1804–1809.

    Article  PubMed  CAS  Google Scholar 

  12. Women’s Health Initiative Study Group: Design of the Women’s Health Initiative clinical trial and observational study. Control Clin Trials 1998, 339:733–738.

    Google Scholar 

  13. LaFleur J, McAdam-Marx C, Kirkness C, Brixner DI: Clinical risk factors for fracture in postmenopausal osteoporotic women: a review of the recent literature. Ann Pharmacother 2008, 42:375–386.

    Article  PubMed  Google Scholar 

  14. Robbins J, Aragaki AK, Kooperberg C, et al.: Factors associated with 5-year risk of hip fracture in postmenopausal women. JAMA 2007, 298:2389–2398.

    Article  PubMed  CAS  Google Scholar 

  15. Black DM, Steinbuch M, Palermo L, et al.: An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 2001, 12:519–528.

    Article  PubMed  CAS  Google Scholar 

  16. Dargent-Molina P, Douchin MN, Cormier C, et al.: Use of clinical risk factors in elderly women with low bone mineral density to identify women at high risk for hip fracture: the EPIDOS prospective study. Osteoporos Int 2002, 13:593–599.

    Article  PubMed  CAS  Google Scholar 

  17. Miller PD, Barles S, Brenneman SK, et al.: An approach for identifying osteopenic women at increased short-term risk of fracture. Arch Intern Med 2004, 164:1113–1120.

    Article  PubMed  Google Scholar 

  18. McGrother CW, Donaldson MM, Clayton D, et al.: Evaluation of a hip fracture risk score for assessing elderly women: the Melton Osteoporotic Fracture (MOF) study. Osteoporos Int 2002, 13:89–96.

    Article  PubMed  CAS  Google Scholar 

  19. Kanis JA, Oden A, Johnell O, et al.: The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 2007, 18:133–1046.

    Article  Google Scholar 

  20. Kanis JA, Johnell O, Johansson H, McCloskey E: FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008, 19:385–397.

    Article  PubMed  CAS  Google Scholar 

  21. Kanis JA, on behalf of the World Health Organization Scientific Group: Assessment of Osteoporosis at the Primary Health Care Level. Technical Report 2008. University of Sheffield, UK: WHO Collaborating Center; 2008.

    Google Scholar 

  22. Siris E, Delmas PD: Assessment of 10-year absolute fracture risk: a new paradigm with worldwide application. Osteoporos Int 2008, 19:383–384.

    Article  PubMed  CAS  Google Scholar 

  23. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al.: Effect of vitamin D on falls: a meta-analysis. JAMA 2004, 291:1999–2006

    Article  PubMed  CAS  Google Scholar 

  24. Lips P: Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 2001, 22:477–501.

    Article  PubMed  CAS  Google Scholar 

  25. Cranney A, Horsley T, O’Donnell S, et al.: Effectiveness and safety of vitamin D in relation to bone health. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Available at Accessed September 9, 2008.

    Google Scholar 

  26. Cauley JA, LaCroix AZ, Wu LL, et al.: Serum vitamin D concentrations and risk for hip fractures. Ann Intern Med 2008, 149:242–250.

    PubMed  Google Scholar 

  27. Lee JS, LaCroix AZ, Wu LL, et al.: Associations of serum sex hormone-binding globulin and sex hormone concentrations with hip fracture risk in postmenopausal women. J Clin Endocrin Metab 2008, 93:1796–1803.

    Article  CAS  Google Scholar 

  28. Lacroix AZ, Lee JS, Wu L, et al.: Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women. J Am Geriatr Soc 2008 Jul 24 (Epub ahead of print).

  29. Cauley JA, Wampler NS, Barnhart JM, et al.: Incidence of fractures compared to cardiovascular disease and breast cancer: the Women’s Health Initiative Observational Study. Osteoporos Int 2008, Jul 16 (Epub ahead of print).

  30. Cauley JA, Wu L, Wampler N, et al.: Clinical risk factors for fractures in multi-ethnic women: the Women’s Health Initiative. J Bone Miner Res 2007, 22:1816–1826.

    Article  PubMed  Google Scholar 

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Correspondence to Rebecca D. Jackson.

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Jackson, R.D., Donepudi, S. & Mysiw, W.J. Epidemiology of fracture risk in the Women’s Health Initiative. Curr Osteoporos Rep 6, 155–161 (2008).

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