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United States Department of Agriculture

Agricultural Research Service

Research Project: MUSCULOSKELETAL HEALTH IN THE ELDERLY

Location: Human Nutrition Research Center on Aging

Title: Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation Guidance

Authors
item Looker, Anne -
item Dawson-Hughes, Bess -
item Tosteson, Anna -
item Johansson, Helena -
item Kanis, John -
item Melton Iii, Joseph -

Submitted to: Osteoporosis International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: April 12, 2010
Publication Date: February 1, 2011
Citation: Looker, A.C., Dawson-Hughes, B., Tosteson, A.N., Johansson, H., Kanis, J.A., Melton Iii, J.L. 2011. Hip fracture risk in older US adults by treatment eligibility status based on new National Osteoporosis Foundation Guidance. Osteoporosis International. 22(2):541-549.

Interpretive Summary: The new National Osteoporosis Foundation Guide for who should be considered for treatment to prevent fractures is based on the World Health Organization’s fracture risk calculator, FRAX®. To evaluate the accuracy of the calculated fracture risk, we used the Medicare data base to identify hip fractures among subjects who had participated in the NHANES III survey which took place from 1988-1994. This group of 3208 men and women age 65 and older had bone density and osteoporosis risk factor information available. We found that the relative risk of hip fracture was increased nearly 5-fold in those men and women who were identified by the new NOF Guide as being at high risk for fracture. The finding that the new NOF guide successfully identified older individuals who are at significant risk of subsequent hip fracture suggests that this Guide may be useful in identifying subjects who should be considered for treatment to prevent fractures.

Technical Abstract: The relationship between treatment eligibility by the new National Osteoporosis Foundation (NOF) FRAX® -based Guide to the Prevention and Treatment of Osteoporosis and the risk of subsequent hip fracture is unknown. The study sample consisted of 3208 men and women ages 65 years and older who were examined in the third National Health and Nutrition Examination Survey (NHANES III, 1988-94), a nationally representative survey. Risk factors used to define treatment eligibility at baseline were measured in NHANES III or were simulated using World Health Organization study cohorts. Incident hip fractures were ascertained using linked mortality and Medicare records that were obtained for NHANES III participants through December 31, 2000. Cox proportional hazards models were used to estimate the relative risk (RR) of hip fracture by treatment eligibility status. The RR for subsequent hip fracture was 4.9 (95% CI 3.30, 7.94) in treatment-eligible versus treatment-ineligible persons. The increased risk for treatment eligible persons remained statistically significant when examined by sex or age: RRmen = 5.5 (2.6, 11.4) and RRwomen = 4.3 (2.2, 8.4); RR65-79 y = 4.8 (2.6, 8.7) and RR80+ y = 4.6 (2.1, 10.1). Treatment-eligible persons were about 5 times more likely to experience a subsequent hip fracture than the non-eligible persons. The new NOF guidelines appear to predict future hip fracture risk as well in men as in women, and fracture risk prediction did not appear to diminish with age.

Last Modified: 8/29/2014