Abstract
ABSTRACTMeasures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for five chair stands, walking speed over a 6 m distance, grip strength, ALM adjusted for body size (ALM/height2), FRAX probability (major osteoporotic fracture [MOF]) with or without femoral neck aBMD, available in a subset of n = 7531), and incident MOF (hip, clinical vertebral, wrist, or proximal humerus). Associations were adjusted for age and time since baseline, and are reported as hazard ratios (HRs) for first incident fracture per SD increment in predictor using meta‐analysis. 5660 men in the United States (mean age 73.5 years), 2764 men in Sweden (75.4 years), and 1987 men in Hong Kong (72.4 years) were studied. Mean follow‐up time was 8.7 to 10.9 years. Greater time for five chair stands was associated with greater risk of MOF (HR 1.26; 95% CI, 1.19 to 1.34), whereas greater walking speed (HR 0.85; 95% CI, 0.79 to 0.90), grip strength (HR 0.77; 95% CI, 0.72 to 0.82), and ALM/height2 (HR 0.85; 95% CI, 0.80 to 0.90) were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but associations between ALM/height2 and MOF were weakened (HR 0.92; 95% CI, 0.85 to 0.99). Inclusion of femoral neck aBMD markedly attenuated the association between ALM/height2 and MOF (HR 1.02; 95% CI, 0.96 to 1.10). Measures of physical performance predicted incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height2 was substantially reduced by inclusion of aBMD requires further study, these findings support the consideration of physical performance in fracture risk assessment. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
Highlights
The place of falls as a major risk factor for fracture is well established; the majority of hip fractures occur as a result of a fall from standing height or less.[1,2] There is substantial evidence that risk factors related to falls risk, such as physical performance, function, and muscle indices, are related to the risk of incident fracture.[3,4,5] Current clinical approaches to risk assessment are increasingly based on clinical risk factors, with or without Areal bone mineral density (aBMD), through fracture risk calculators
FRAX is the most commonly used fracture risk assessment tool worldwide,(6) but unlike other tools such as QFracture or the GARVAN calculator,(7–9) it does not include falls as a specific input risk factor[2,10] because of the inconsistent data across the 12 derivation and 11 validation cohorts.[11]. We have previously demonstrated that prior falls predict the risk of incident falls[12] and fractures[13] independently of FRAX probability
We undertook a meta-analysis of the three Osteoporotic Fractures in Men (MrOS) cohorts (United States, Sweden, Hong Kong) to investigate whether the predictive value of four measures for incident fracture was independent of FRAX probability, history of falls, or aBMD
Summary
The place of falls as a major risk factor for fracture is well established; the majority of hip fractures occur as a result of a fall from standing height or less.[1,2] There is substantial evidence that risk factors related to falls risk, such as physical performance, function, and muscle indices, are related to the risk of incident fracture.[3,4,5] Current clinical approaches to risk assessment are increasingly based on clinical risk factors, with or without aBMD, through fracture risk calculators. The predictive value of falls-related risk factors for incident fracture have been demonstrated individually,(4,5) it has not been established whether the risk information so provided will be independent of that obtained through FRAX and aBMD This is an important consideration because if these measures were to provide no additional information beyond the current fracture risk assessment, there would be little to be gained from their measurement as part of fracture-risk stratification. It is not clear whether specific falls risk factors, such as physical performance, might give information independent of the reporting of prior falls themselves. We undertook a meta-analysis of the three Osteoporotic Fractures in Men (MrOS) cohorts (United States, Sweden, Hong Kong) to investigate whether the predictive value of four measures (time for five chair stands, walking speed over a distance of 6 m, grip strength, and appendicular lean mass [ALM]) for incident fracture was independent of FRAX probability, history of falls, or aBMD
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