General Comorbidity Indicators Contribute to Fracture Risk Independent of FRAX: Registry-Based Cohort Study
Authors' conclusion
Both complex and simple measures of medical comorbidity may be used to modify FRAX-based risk estimates to capture the increased fracture risk associated with multiple comorbid conditions in older patients.
Study context
- Population
- Women and men aged ≥40 in the Manitoba BMD Registry (1996–2016) with ≥3 years prior health care data
- Exposure
- Increasing ADG score or number of hospitalizations vs lower comorbidity
- Outcome
- Incident major osteoporotic fracture and hip fracture
- Follow-up
- Average 9 years
Methodological detailsregistry-based, linked administrative databases
- Registry-based
- Linked administrative databases
Main finding
As reported in the abstract
Hospitalizations and ADG score independently increased the HR for fracture at all levels of comorbidity, irrespective of adjustment for FRAX, BMD and competing mortality
hazard range 1.2-1.8
all P < 0.05
Observational data: associations, not effects.
Further findings
Fracture with hospitalizations and ADG score taken together
- Higher than predicted fracture rate at all levels of increased comorbidity, independent of FRAX and BMD but attenuated by competing mortality
Treatment candidates at major fracture risk >20% threshold with comorbidity HR multiplier applied to FRAX
- Treatment candidates would increase
- from 8.6% to 14.4%
Original publication
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