MInneapolis, MN—Which women older than age 80 years have the greatest likelihood of hip fracture and would most benefit from drug treatment, taking into account competing mortality risks?
A study published in JAMA Internal Medicine provides an answer to that question, finding that that those with osteoporosis, including those with more comorbidities or poorer prognosis, have a high hip fracture probability despite accounting for competing mortality risk.
University of Minnesota–led researchers from the Study of Osteoporotic Fractures Research Group suggest those patients are the likeliest candidates for medications to prevent hip fractures.
One problem, according to the study, is that advanced age is often associated with lower use of drug treatment to prevent fractures. Researchers note that concerns about comorbidities and prognosis make managing osteoporosis much more complex in the older age group.
“While advanced age is associated with lower rates of drug treatment to prevent fracture, the estimated five-year hip fracture risk is high among women 80 years and older, with probabilities ranging from 7.1% among those 80 to 84 years up to 20.9% among those 90 years and older,” according to study authors.
“Approximately 33% of women who survive to age 90 years will experience a hip fracture by that age, but the estimated lifetime risk of hip fracture among postmenopausal women is much lower at 17% because most women die of other causes unrelated to hip fracture prior to reaching age 90. Older age, low bone mineral density (BMD), and poorer health status are risk factors for hip fracture, but they also increase the risk of competing mortality. Thus, clinicians have difficulty identifying late-life women most likely to benefit from drug treatment to prevent hip fracture.”
That’s why the study team sought to determine the association of disease definition, number of comorbidities, and prognosis with 5-year hip fracture probabilities among women who are aged 80 years and older.
The prospective cohort study was conducted at four sites in the United States and included 1,528 community-dwelling women identified as potential candidates for initiation of osteoporosis drug treatment.
Participants were divided into two groups based on disease definition criteria proposed by the National Bone Health Alliance—761 with osteoporosis and 767 without osteoporosis but at high fracture risk. All analyses were performed between March 2018 and January 2019.
Researchers contacted participants, who had an average age of 84.1 years, every 4 months to collect information on vital status and hip fracture. The 5-year hip fracture probability was then calculated, taking into account any competing mortality risk.
During follow-up, the authors report, 8.0% of the women suffered a hip fracture and 18.8% died before experiencing this event. Five-year mortality probability was calculated at 24.9% (95% CI, 21.8-28.1) among women with osteoporosis and 19.4% (95% CI, 16.6-22.3) among women without osteoporosis but at high fracture risk.
The study found that in both groups, mortality probability similarly increased with more comorbidities and poorer prognosis. On the other hand, 5-year hip fracture probability was 13.0% (95% CI, 10.7-15.5) among women with osteoporosis and 4.0% (95% CI, 2.8-5.6) among women without osteoporosis but at high fracture risk.
Researchers explained that the difference was greatest among women with more comorbidities or worse prognosis, offering as an example that among women with three or more comorbid conditions, hip fracture probability was 18.1% (95% CI, 12.3-24.9) among women with osteoporosis versus 2.5% (95% CI, 1.3-4.2) among women without osteoporosis but at high fracture risk.
“Women 80 years and older who have osteoporosis, including those with more comorbidities or poorer prognosis, have a high five-year probability of hip fracture despite accounting for competing mortality risk,” study authors conclude. “In contrast, among women without osteoporosis but at high fracture risk, competing mortality risk far outweighs hip fracture probability, especially among those with more comorbidities or worse prognosis.”
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A study published in JAMA Internal Medicine provides an answer to that question, finding that that those with osteoporosis, including those with more comorbidities or poorer prognosis, have a high hip fracture probability despite accounting for competing mortality risk.
University of Minnesota–led researchers from the Study of Osteoporotic Fractures Research Group suggest those patients are the likeliest candidates for medications to prevent hip fractures.
One problem, according to the study, is that advanced age is often associated with lower use of drug treatment to prevent fractures. Researchers note that concerns about comorbidities and prognosis make managing osteoporosis much more complex in the older age group.
“While advanced age is associated with lower rates of drug treatment to prevent fracture, the estimated five-year hip fracture risk is high among women 80 years and older, with probabilities ranging from 7.1% among those 80 to 84 years up to 20.9% among those 90 years and older,” according to study authors.
“Approximately 33% of women who survive to age 90 years will experience a hip fracture by that age, but the estimated lifetime risk of hip fracture among postmenopausal women is much lower at 17% because most women die of other causes unrelated to hip fracture prior to reaching age 90. Older age, low bone mineral density (BMD), and poorer health status are risk factors for hip fracture, but they also increase the risk of competing mortality. Thus, clinicians have difficulty identifying late-life women most likely to benefit from drug treatment to prevent hip fracture.”
That’s why the study team sought to determine the association of disease definition, number of comorbidities, and prognosis with 5-year hip fracture probabilities among women who are aged 80 years and older.
The prospective cohort study was conducted at four sites in the United States and included 1,528 community-dwelling women identified as potential candidates for initiation of osteoporosis drug treatment.
Participants were divided into two groups based on disease definition criteria proposed by the National Bone Health Alliance—761 with osteoporosis and 767 without osteoporosis but at high fracture risk. All analyses were performed between March 2018 and January 2019.
Researchers contacted participants, who had an average age of 84.1 years, every 4 months to collect information on vital status and hip fracture. The 5-year hip fracture probability was then calculated, taking into account any competing mortality risk.
During follow-up, the authors report, 8.0% of the women suffered a hip fracture and 18.8% died before experiencing this event. Five-year mortality probability was calculated at 24.9% (95% CI, 21.8-28.1) among women with osteoporosis and 19.4% (95% CI, 16.6-22.3) among women without osteoporosis but at high fracture risk.
The study found that in both groups, mortality probability similarly increased with more comorbidities and poorer prognosis. On the other hand, 5-year hip fracture probability was 13.0% (95% CI, 10.7-15.5) among women with osteoporosis and 4.0% (95% CI, 2.8-5.6) among women without osteoporosis but at high fracture risk.
Researchers explained that the difference was greatest among women with more comorbidities or worse prognosis, offering as an example that among women with three or more comorbid conditions, hip fracture probability was 18.1% (95% CI, 12.3-24.9) among women with osteoporosis versus 2.5% (95% CI, 1.3-4.2) among women without osteoporosis but at high fracture risk.
“Women 80 years and older who have osteoporosis, including those with more comorbidities or poorer prognosis, have a high five-year probability of hip fracture despite accounting for competing mortality risk,” study authors conclude. “In contrast, among women without osteoporosis but at high fracture risk, competing mortality risk far outweighs hip fracture probability, especially among those with more comorbidities or worse prognosis.”
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