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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.
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