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

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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.

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Ackowledgements

The authors would like to thank the rest of the CaMos Research Group including: J. Allan, L. Blondeau, A Cranney, B. Gardner-Bray, P. Hartman, C. Joyce J. Kedra, N. Kreiger, P.Krutzen, S. Godmairid, E. Lejeune, B.C. Lentle, B. Matthews, N. Migneault-Roy, M. Parsons, R.S. Rittmaster, L. Robertson, B. Stanfield, A. Tenenhouse, and Y. Vigna. L. Joseph is a senior scientist funded by CIHR. CaMos was funded by the Senior’s Independence Research Program through the National Health Research and Development Program (project no. 6605–4003-OS), the Medical Research Council of Canada–Pharmaceutical Manufacturers Association of Canada (MRC–PMAC) Health Program, Merck Frosst Canada Inc., Eli Lilly Canada Inc., Procter & Gamble Pharmaceuticals Canada Inc., the Dairy Farmers of Canada, and The Arthritis Society.

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Authors and Affiliations

  1. Department of Medicine, St. Joseph’s Hospital, McMaster University, Hamilton, Ontario, Canada

    Alexandra Papaioannou, George Ioannidis, Laura Pickard & Jonathan D. Adachi

  2. Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada

    Lawrence Joseph

  3. CaMos Analysis Centre, McGill University, Montreal, Quebec, Canada

    Claudie Berger

  4. Division of Rheumatology, Department of Medicine; Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada

    Tassos Anastassiades

  5. Department of Medicine, Laval University, Ste-Foy, Quebec, Canada

    Jacques P. Brown

  6. Department of Medicine, University of Calgary, Calgary, Alberta, Canada

    David A. Hanley

  7. Clinical Research Centre, Kingston General Hospital and the Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada

    Wilma Hopman

  8. Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

    Robert G. Josse & Timothy M. Murray

  9. Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada

    Susan Kirkland

  10. Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

    Wojciech P. Olszynski

  11. Department of Medicine/ Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada

    Jerilynn C. Prior

  12. Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Alberta, Edmonton, Canada

    Kerry Siminoski

  13. Chedoke Division, Geriatric Medicine, Hamilton Health Sciences Corporation, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada

    Alexandra Papaioannou

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  1. Alexandra Papaioannou
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  2. Lawrence Joseph
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  3. George Ioannidis
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Correspondence to Alexandra Papaioannou.

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Papaioannou, A., Joseph, L., Ioannidis, G. et al. Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 16, 568–578 (2005). https://doi.org/10.1007/s00198-004-1735-x

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