Testing a theoretical model of imminent fracture risk in elderly women:​ an observational cohort analysis of the Canadian Multicentre Osteoporosis Study

Papaioannou, A.; Adachi, J. D.; Berger, C.; Jiang, Y.; Barron, R.; McGinley, J. S.; Wirth, R. J.; Anastassiades, T. P.; Davison, K. S.; Hanley, D. A.; Ioannidis, G.; Kaiser, S. M.; Kovacs, C. S.; Leslie, W. D.; Morin, S. N.; Prior, J. C.; Towheed, T.; Goltzman, D.

Affiliations

¹McMaster University, Hamilton, Canada

²Research Institute of the McGill University Health Centre, Montreal, Canada

³Amgen Inc., One Amgen Center Drive, Thousand Oaks, USA

⁴Vector Psychometric Group, LLC, Chapel Hill, USA

⁵Queen’s University, Kingston, Canada

⁶University of Victoria, Victoria, Canada

⁷Cumming School of Medicine, University of Calgary, Calgary, Canada

⁸Dalhousie University, Halifax, Canada

⁹Memorial University of Newfoundland, St. John’s, Canada

¹⁰University of Manitoba, Winnipeg, Canada

¹¹McGill University, Montreal, Canada

¹²University of British Columbia, Vancouver, Canada

Abstract and keywords

Summary: We examined the underlying relationship between fracture risk factors and their imminent risk. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher imminent fracture risk. Past year falls indirectly predicted imminent risk through physical functioning and general health.

Introduction: This study aimed to examine direct and indirect effects of several factors on imminent (1 year) fracture risk.

Methods: Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI).

Results: The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ²(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001).

Conclusions: We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.

Keywords: CaMos; epidemiology; fracture risk; imminent; older women; osteoporosis

Links

DOI: 10.1007/s00198-020-05330-2

PubMed: 32034452

WoS: 000516153600001

History

Received: 2019-01-22

Accepted: 2020-02-03

Online: 2020-02-07

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