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A woman’s age alone might predict her risk for osteoporotic fractures as effectively as more comprehensive, official risk prediction models would, a comparison study reveals.
This does not mean, however, that age alone should be considered at this point, Xuezhi Jiang, MD, from the Department of Obstetrics-Gynecology and the Department of Internal Medicine at the Reading Hospital in Pennsylvania, and colleagues write in the October issue of Obstetrics & Gynecology.
“Although age alone should not be used as an independent predictor of fractures, data from this study suggest that age should be carefully considered when evaluating patients for osteoporosis screening and treatment,” they write.
“[I]t is not recommended to abandon the osteoporotic fracture prediction models, because there is no better alternative model available currently,” they add.
In their study of 615 menopausal-age women, age greater than 65 years emerged as a significant predictor of osteoporotic fracture risk and was as reliable a predictor as the World Health Organization Fracture Risk Assessment Tool and the North American Menopause Society osteoporosis treatment guidelines from 2006 and 2010.
A total of 15 women in this cohort experienced a fracture. Their mean age was 70.7 years vs 61.2 years among those without a fracture history. The difference was statistically significant (P < .001). More than half of the 15 women who had a fracture (60%) were also diagnosed with osteoporosis compared with 10% of the 600 fracture-free women (P < .001).
Age alone is a significant predicting factor for fracture (area under the curve (AUC), 0.79; 95% confidence interval [CI], 0.67 – 0.91; P < .001). Using an optimal cutoff at age 65 years produced a sensitivity of 80% and a specificity of 73%. In comparison, the AUC for the Fracture Risk Assessment Tool was 0.76 (95% CI, 0.64 – 0.89), and the AUC for the North American Menopause Society Treatment Guideline 2010 was 0.77 (95% CI, 0.66 – 0.88).
Compared with postmenopausal women younger than 65 years, the adjusted odds ratio for fracture in older women was 10.2, after adjusting for race, smoking, steroid use, parent hip fracture, and rheumatoid arthritis.
The researchers determined that 9 of the 15 women carried a sufficient fracture risk to require treatment according to the Fracture Risk Assessment Tool. Similarly, 9 and 12 of the women would require treatment according to the North American Menopause Society position statements from 2006 and 2010, respectively.
“In our analysis, all three prediction models were effective tools for predicting fractures,” the authors write. “However, it appears that all of these models are no better predictors of fracture than age alone. The data indicate that age may be at least as good of a fracture predictor as the North American Menopause Society 2010 guidelines and the Fracture Risk Assessment Tool with [bone mineral density].”
Dr. Jiang and colleagues recruited women older than 49 years for the study between January 1, 2007, and March 1, 2009. Because the study was retrospective, all women who had a fracture experienced it before entry into the study, which is a potential limitation. Future, prospective studies are warranted, according to the authors, to optimize a screening instrument and to further validate current risk prediction models.