Clinical risk factors for fracture in postmenopausal osteoporotic women: A review of the recent literature

OBJECTIVE: To review recent literature regarding relationships among age, weight or body mass index (BMI), bone mineral density (BMD), maternal history of fracture, or personal prior history of fracture and fragility fractures in women with postmenopausal osteoporosis (PMO). DATA SOURCES: A MEDLINE database search (1995-June 30, 2007) was conducted to identify literature related to risk factors of interest for PMO-related fractures. STUDY SELECTION AND DATA EXTRACTION: Cohort studies, case-control studies, and meta-analyses that reported fracture outcomes were included if they provided an estimate of relative risk for at least 1 of the 5 selected clinical risk factors (CRFs) and studied women with PMO or stratified risk estimates by age and sex. Of 313 identified studies that evaluated fractures as an endpoint, 245 did not report risk estimates for a CRIF of interest and/or did not report data for a PMO population. DATA SYNTHESIS: In the 68 included articles, the risks associated with the evaluated CRFs were high and significant. Prior fracture was a strong predictor of fracture and increased risk up to 18 times. Each standard deviation below the referent mean for BMD was associated with an increased fracture risk of up to 4.0 times; maternal fracture history increased risk 1.3-2.9 times. Age (per 5 year increment) increased risk by 1.2-5.0 times; low weight or BMI inconsistently showed a 0.5-3.0 times greater risk. CONCLUSIONS: Low BMD is widely used as a diagnostic indicator for osteoporosis; however, other CRFs play an important role in determining fracture risk among women with PMO.