Predictors of imminent non-vertebral fracture in elderly women with osteoporosis, low bone mass, or a history of fracture, based on data from the population-based Canadian Multicentre Osteoporosis Study (CaMos)

Using data from the Canadian Multicentre Osteoporosis Study, several risk factors predictive of imminent (2-year) risk of low-trauma non-vertebral fracture among high-risk women were identified, including history of falls, history of low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to targeting this population for therapy.PurposeFracture risk assessment has focused on a long-term horizon and populations with a broad risk range. For elderly women with osteoporosis or low bone mass, or a history of fragility fractures (high-risk women), risk prediction over a shorter horizon may have greater clinical relevance.MethodsA repeated-observations design and data from the Canadian Multicentre Osteoporosis Study were employed. Study population comprised women aged 65years with T score (total hip, femoral neck, spine) -1.0 or prior fracture. Hazard ratios (HR) for predictors of low-trauma non-vertebral fracture during 2-year follow-up were estimated using multivariable shared frailty model.ResultsThe study population included 3228 women who contributed 5004 observations; 4.8% experienced low-trauma non-vertebral fracture during the 2-year follow-up. In bivariate analyses, important risk factors included age, back pain, history of falls, history of low-trauma fracture, physical function, health status, and total hip T score. In multivariable analyses, only four independent predictors were identified: falls in past 12months (2 falls: HR=1.9; 1 fall: HR=1.5), low-trauma fracture in past 12months (1 fracture: HR=1.7), SF-36 physical component summary score (42.0: HR=1.6), and total hip T score (-3.5: HR=3.7; >-3.5 to -2.5: HR=2.5; >-2.5 to -1: HR=1.3).ConclusionsImminent risk of low-trauma non-vertebral fracture is elevated among high-risk women with a history of falls or low-trauma fracture, poorer physical function, and lower T score. Careful consideration should be given to identifying and targeting this population for therapy.