 |
|
An Approach to Identifying Osteopenic Women at Increased Short-term Risk of Fracture
Paul D. Miller, MD;
Suna Barlas, PhD;
Susan K. Brenneman, PT, PhD;
Thomas A. Abbott, PhD;
Ya-Ting Chen, PhD;
Elizabeth Barrett-Connor, MD;
Ethel S. Siris, MD
Arch Intern Med. 2004;164:1113-1120.
Background Identification and management of women to reduce fractures is often limited to T scores less than –2.5, although many fractures occur with higher T scores. We developed a classification algorithm that identifies women with osteopenia (T scores of –2.5 to –1.0) who are at increased risk of fracture within 12 months of peripheral bone density testing.
Methods A total of 57 421 postmenopausal white women with baseline peripheral T scores of –2.5 to –1.0 and 1-year information on new fractures were included. Thirty-two risk factors for fracture were entered into a classification and regression tree analysis to build an algorithm that best predicted future fracture events.
Results A total of 1130 women had new fractures in 1 year. Previous fracture, T score at a peripheral site of –1.8 or less, self-rated poor health status, and poor mobility were identified as the most important determinants of short-term fracture. Fifty-five percent of the women were identified as being at increased fracture risk. Women with previous fracture, regardless of T score, had a risk of 4.1%, followed by 2.2% in women with T scores of –1.8 or less or with poor health status, and 1.9% for women with poor mobility. The algorithm correctly classified 74% of the women who experienced a fracture.
Conclusions This classification tool accurately identified postmenopausal women with peripheral T scores of –2.5 to –1.0 who are at increased risk of fracture within 12 months. It can be used in clinical practice to guide assessment and treatment decisions.
From the Colorado Center for Bone Research, Lakewood, and the University of Colorado Health Sciences Center, Denver (Dr Miller); the Department of Outcomes Research and Management, Merck & Co Inc, West Point, Pa (Drs Barlas, Brenneman, Abbott, and Chen); the Department of Family and Preventive Medicine, University of California, San Diego, La Jolla (Dr Barrett-Connor); and the College of Physicians and Surgeons, Columbia University, New York, NY (Dr Siris). Drs Miller, Barrett-Connor, and Siris receive consulting fees from Merck & Co Inc to compensate them for time spent working on the NORA project.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Osteoporosis Screening: Time to Take Responsibility
Daniel Mazanec
Arch Intern Med. 2004;164(10):1047-1048.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The early prediction of mortality in acute pancreatitis: a large population-based study
Wu et al.
Gut 2008;57:1698-1703.
ABSTRACT
| FULL TEXT
The Role of Bone Biopsy in Patients with Chronic Renal Failure
Miller
CJASN 2008;3:S140-S150.
ABSTRACT
| FULL TEXT
Bone and Fall-Related Fracture Risks in Women and Men with a Recent Clinical Fracture
van Helden et al.
JBJS 2008;90:241-248.
ABSTRACT
| FULL TEXT
Drugs for pre-osteoporosis: prevention or disease mongering?
Alonso-Coello et al.
BMJ 2008;336:126-129.
FULL TEXT
Low bone mineral density and fracture burden in postmenopausal women
Cranney et al.
CMAJ 2007;177:575-580.
ABSTRACT
| FULL TEXT
Framework for Evaluating Disease Severity Measures in Older Adults With Comorbidity
Boyd et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2007;62:286-295.
ABSTRACT
| FULL TEXT
Risk Factors for Fracture in Nonosteoporotic Men and Women
Nguyen et al.
J. Clin. Endocrinol. Metab. 2007;92:955-962.
ABSTRACT
| FULL TEXT
A 55-Year-Old Woman With Osteopenia
Cummings
JAMA 2006;296:2601-2610.
ABSTRACT
| FULL TEXT
Alendronate and Vertebral Fracture Risk-1
Mikhail and Cope
Mayo Clin Proc. 2005;80:1236-1236.
Cost-Effectiveness of Alendronate Therapy for Osteopenic Postmenopausal Women
Schousboe et al.
ANN INTERN MED 2005;142:734-741.
ABSTRACT
| FULL TEXT
Hip Fracture in Women without Osteoporosis
Wainwright et al.
J. Clin. Endocrinol. Metab. 2005;90:2787-2793.
ABSTRACT
| FULL TEXT
Four Questions to Determine Fracture Risk in Osteopenic Women
JWatch Women's Health 2004;2004:2-2.
FULL TEXT
Should Thresholds for Bone Mineral Density Treatment Be Lowered?
JWatch Gastroenterology 2004;2004:11-11.
FULL TEXT
Should Thresholds for Bone Mineral Density Treatment Be Lowered?
JWatch General 2004;2004:1-1.
FULL TEXT
Osteoporosis Screening: Time to Take Responsibility
Mazanec
Arch Intern Med 2004;164:1047-1048.
FULL TEXT
|
