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    Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)

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    Authors
    Dennison, Elaine M.
    Compston, Juliet E.
    Flahive, Julie
    Siris, Ethel S.
    Gehlbach, Stephen H.
    Boonen, Steven
    Chapurlat, Roland D.
    Diez-Perez, Adolfo
    Anderson, Frederick A. Jr.
    Hooven, Frederick H.
    LaCroix, Andrea Z.
    Lindsay, Robert
    Netelenbos, J. Coen
    Pfeilschifter, Johannes
    Rossini, Maurizio
    Roux, Christian
    Saag, Kenneth G.
    Sambrook, Phillip N.
    Silverman, Stuart
    Watts, Nelson B.
    Greenspan, Susan L.
    Premaor, Melissa
    Cooper, Cyrus
    Show allShow less
    UMass Chan Affiliations
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2012-06-01
    Keywords
    Osteoporosis
    Osteoporosis, Postmenopausal
    Osteoporotic Fractures
    Fractures, Bone
    Health Services Research
    Musculoskeletal Diseases
    
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    Link to Full Text
    http://dx.doi.org/10.1016/j.bone.2012.02.639
    Abstract
    INTRODUCTION: Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. MATERIALS AND METHODS: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. RESULTS: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. CONCLUSION: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.
    Source
    Bone. 2012 Jun;50(6):1288-93. Epub 2012 Mar 9. Link to article on publisher's site
    DOI
    10.1016/j.bone.2012.02.639
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27165
    PubMed ID
    22426498
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.bone.2012.02.639
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