Three Questions Predict Fracture Risk | Arthritis Information

According to Elizabeth Barrett-Connor, M.D., of the University of California San Diego, those three questions are:

• Is there a prior history of fractures?
• Does the patient have a bone mineral density T-score of no more than minus 1.1?
• Does she report herself to be in poor or fair general health?

A diagnostic algorithm based on those questions is enough to pick out women who are at five-fold increased risk of fracture, Dr. Barrett-Connor told attendees at the annual meeting of the American Society for Bone and Mineral Research.

"I think the model is pretty impressive," she said after her presentation.

Dr. Barrett-Connor and colleagues analyzed data from 91,561 women, ages 50 through 64, who took part in the National Osteoporosis Risk Assessment Survey (NORA), which involved women from more than 4,000 private practices in the U.S.

Women with a history of osteoporosis or on a medication specific for osteoporosis were excluded, she said.

The volunteers were enrolled from September 1997 through March 1999 and were given a baseline questionnaire and bone mineral density measurement. Follow-up surveys, including self-reported fractures, took place at years one, three, and six.

Of the cohort, 5,562 women reported previous fractures, 22,710 had a T-score of minus 1.1 or less but no previous fractures, and 8,466 said their health was fair or poor but had no previous fractures and a T-score above the cut-off.

Another 54,823 had none of the three factors, Dr. Barrett-Connor said.

The researchers found that 10.1% of women with a previous broken bone had a subsequent fracture at any site, compared with 4.8% of those below the T-score cut-off, 3.8% of those in poor or fair health, and 2.2% of those who had none of the factors.

Compared with the 54,823 women who had none of the three factors:

• Those with a previous history of fracture had a relative risk of 4.9 of having another fracture within the six-year study period. The 95% confidence interval ranged from 4.5 to 5.5.
• Those below the T-score cut-off had a relative risk of 2.2 for having another broken bone. The 95% confidence interval ranged from 2.1 to 2.4.
• Those who said their health was poor or fair had a relative fracture risk of 1.9, with a 95% confidence interval from 1.6 to 2.1.

Results of bone mineral density testing -- not routinely recommended for women younger than 65 -- only marginally predicted an increased risk of future fracture compared with history of previous fracture and self-assessed health as poor or fair.

Dr. Barrett-Connor pointed out that the women in the study are not representative of all post-menopausal women. For one thing, she said, "they all had doctors, they all had health insurance, and they all could have done something about these things had they been found and thought to be important."

She added that by the study definition none of the women had osteoporosis.

The study is important, said Meryl LeBoff, M.D., of Brigham and Women's Hospital in Boston, who moderated the session at which the data were presented and who was not involved in the research.

"Younger women do fracture and (the study) gives an analysis of fractures in this younger group," she said.