Lisa Langsetmo, PhD
When diagnosed with osteoporosis, women aged 80 years or older face a three-fold probability of a hip fracture within 5 years, according to a new diagnosis for the Study of Osteoporotic Fractures (SOF) Research Group.
The severity is sharpened even further for girls diagnosed with comorbidities or bad diagnosis.
The investigators, led by way of Lisa Langsetmo, PhD, of the University of Minnesota Twin Cities, conducted a prospective cohort study from March 2018 – January 2019 across 4 US sites, including 1528 ladies (mean age 84.1 years) identified as in all probability in a position to advantage from osteoporosis remedy.
The 1528 ladies are from a larger customary pattern pool of 9704 women aged 65 years or older from 1986 – 1988.
At that time, the followed ladies were able to walk unassisted. From 2002-2004, all active, surviving women were influenced to take part in a 16-year follow-up visit, most effective 4261 women (88% of surviving participants) to return questionnaire data, and 2692 of these to complete an in-clinical examination, adding measurement of hip bone mineral density (BMD).
The final analytical cohort contained 1528 girls who had never been previously treated for osteoporosis.
Not all of these ladies in the cohort were diagnosed with osteoporosis—they were divided into 2 organizations based mostly on the National Bone Health Alliance’s disease definition criteria for having clinical osteoporosis (n= 761) or being without osteoporosis having said that at top fracture chance (n= 767).
Use of drug cure to prevent fractures decreases as age increases. Concerns approximately comorbidities and analysis, however, also augment with age.
Randomized clinical trials among women and men aged 50 years and older have shown that the ones with clinically diagnosed osteoporosis advantage significantly from drug remedy that prevents fractures. Unfortunately, the majority of those trials exclude or underrepresent girls aged 80 or older and/or girls with multiple comorbidities or poorer diagnosis.
As a result, extra analysis is necessary to determine the proper path of movement for older ladies with osteoporosis, who face no longer most effective the chance of a associated fracture, nonetheless age-related mortality risks.
The 1528 girls in the final stage of the new study were contacted each and every 4 months concerning their ordinary health and any hip fractures. The five-year hip fracture opportunity also accounted for competing mortality possibility and comorbid stipulations assessed by self-report, as smartly as analysis estimated using a mortality prediction index. Components considered when selecting mortality chance blanketed age, sex, true comorbid prerequisites, body mass index, and issue performing traditional and instrumental events of daily living, all of which affected mortality cost on an index variety of 0 – 21.
During the following 5 years, 125 (8%) of the women experienced a hip fracture. Just 287 (18.8%) died without ever experiencing a hip fracture.
The 5-year mortality possibility become 24.9% (95% CI: 21.8 – 28.1) among women with osteoporosis as as compared to 19.4% (95% CI: 16.6 – 22.3) among ladies who were most effective at top fracture possibility.
Both organizations saw an increase in mortality along comorbidities and poorer prognosis.
Fracture probability across 5 years, on the other hand, turned into 13% (95% CI: 10.7 – 15.5) among women with osteoporosis and 4% (95% CI: 2.8 – 5.6) among the other group. Comorbidities or worse diagnosis extra broadened the difference. Among women with 3 or more comorbid stipulations, hip fracture possibility was 18.1% (95% CI: 12.3 – 24.9) among women with osteoporosis, while it changed into 2.5% (95% CI: 1.3 – 4.2) among the other group.
In summary, ladies with osteoporosis who are at least 80 years historical have a high five-year possibility of hip fracture, even whilst comorbidities, poor analysis, and competing mortality possibility are taken into account. Women who have a top fracture chance even so in spite of this do not have osteoporosis face a contrarian burden: their possibility of hip fracture is enormously outweighed by means of their mortality chance, which is worsened by way of comorbidities or negative prognosis.
An accompanying commentary, written by means of a trio of investigators from Harvard Medical School, explored how this counsel ought to affect the decision to treat osteoporosis with drugs (or now not) in older feminine patients.
If a patient is doubtless to die previous to ever soreness a fracture, then osteoporosis treatment shouldn’t take priority. On the other hand, if girls 80 or older do, as the new study shows, face higher risk of fracture than of death from other causes, then proceeding with drug cure is a logical resolution.
This is especially relevant in pale of a survey of older women, brought up by the commentary, in which 80% said a option for death quite than a hip fracture foremost to institutionalization.
The study, “Association of Disease Definition, Comorbidity Burden, and Prognosis With Hip Fracture Probability Among Late-Life Women,” became published online in JAMA.