Journal
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
Volume 99, Issue 3, Pages 817-826Publisher
ENDOCRINE SOC
DOI: 10.1210/jc.2013-3468
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Funding
- Warner Chilcott Company, LLC
- Sanofi
- Alliance for Better Bone Health (Procter & Gamble Pharmaceuticals, Sanofi)
- Servier
- Procter Gamble
- Lilly
- Nycomed
- Acuitas
- French Ministry of Health
- Merck
- Amgen
- Kyphon
- Novartis
- Roche
- GE Lunar
- Alliance for Better Bone Health
- Roche-GSK
- Eli Lilly
- Warner Chilcott
- Pfizer
- Daiichi-Sankyo
- Roche Diagnostics
- (University of Cincinnati) from Amgen
- NPS
- Eli Lilly Co
- Wyeth
- Alliance
- Medical Research Council [MC_UU_12011/1, MC_UP_A620_1014, U1475000001, MC_U147585824] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0508-10082, NF-SI-0513-10085] Funding Source: researchfish
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Context: Several fracture prediction models that combine fractures at different sites into a composite outcome are in current use. However, to the extent individual fracture sites have differing risk factor profiles, model discrimination is impaired. Objective: The objective of the study was to improve model discrimination by developing a 5-year composite fracture prediction model for fracture sites that display similar risk profiles. Design: This was a prospective, observational cohort study. Setting: The study was conducted at primary care practices in 10 countries. Patients: Women aged 55 years or older participated in the study. Intervention: Self-administered questionnaires collected data on patient characteristics, fracture risk factors, and previous fractures. Main Outcome Measure: The main outcome is time to first clinical fracture of hip, pelvis, upper leg, clavicle, or spine, each of which exhibits a strong association with advanced age. Results: Of four composite fracture models considered, model discrimination (c index) is highest for an age-related fracture model (c index of 0.75, 47 066 women), and lowest for Fracture Risk Assessment Tool (FRAX) major fracture and a 10-site model (c indices of 0.67 and 0.65). The unadjusted increase in fracture risk for an additional 10 years of age ranges from 80% to 180% for the individual bones in the age-associated model. Five other fracture sites not considered for the age-associated model (upper arm/shoulder, rib, wrist, lower leg, and ankle) have age associations for an additional 10 years of age from a 10% decrease to a 60% increase. Conclusions: After examining results for 10 different bone fracture sites, advanced age appeared the single best possibility for uniting several different sites, resulting in an empirically based composite fracture risk model.
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