BACKGROUND AND PURPOSE:

• Older women, especially those with multiple comorbidities, are less likely to receive medications to prevent hip fracture despite increased risk of fracture in this population
• Fracture probability
  • 80 to 84 years: 7.1%
  • ≥90 years: 20.9%
• It may be difficult to determine who will benefit from preventative treatment as medical comorbidities may also place women at increased risk for competing mortality, unrelated to hip fracture
  • Concern that patient may be more likely to die from other causes prior to suffering a hip fracture
• Ensrud et al. (JAMA Internal Medicine, 2019) studied the possible risk factors and associations to determine which women ≥80 years of age may be candidates for medication to prevent hip fracture

METHODS:

• Prospective cohort study
• Participants
  • Community-dwelling women ≥80 years of age
  • Possible candidates for initiation of osteoporosis drug treatment
• Participants were classified in 2 groups (National Bone Health Alliance criteria)
  • With osteoporosis
  • Without osteoporosis but still at a high fracture risk due to osteopenia or has experienced a confirmed distal forearm, proximal humerus, or pelvis fracture
• Data collection and analysis
  • Women were contacted every 4 months to determine vital status and whether they had experienced a hip fracture
  • 5-year hip fraction probability was calculated while accounting for competing mortality risk
  • Comorbid conditions were assessed by self-report
  • Prognosis was estimated using a mortality prediction index

RESULTS:

• 1,528 women were included
  • With osteoporosis group: 761
  • Without osteoporosis but at a high fracture risk group: 767
  • Mean (SD) age: 84.1 (3.4) years
• During follow-up
  • 8% experienced a hip fracture | 18.8% died before experiencing a hip fracture
• Five-year mortality probability
  • With osteoporosis: 24.9% (95% CI, 21.8 to 28.1)
  • Without osteoporosis but at a high fracture risk: 19.4% (95% CI, 16.6 to 22.3)
  • In both groups, mortality probability increased with more comorbidities and poorer prognosis
• 5-year hip fracture probability
  • With osteoporosis: 13.0% (95% CI, 10.7 to 15.5)
  • Without osteoporosis but at a high fracture risk: 4.0% (95% CI, 2.8 to 5.6)
• Greatest difference in 5-year hip fracture probability was most pronounced in those with more comorbidities or worse prognosis
  • Hip fracture probability with ≥3 comorbid conditions:
    • With osteoporosis: 18.1% (95% CI, 12.3 to 24.9)
    • Without osteoporosis but at a high fracture risk: 2.5% (95% CI, 1.3 to 4.2)

CONCLUSION:

• The 5-year probability of hip fracture is high among women with osteoporosis in women ≥80 years, even when accounting for competing mortality risk
• Women without osteoporosis but at high fracture risk are more likely to die from other causes and will derive less benefit from treatment
• The authors conclude

…late-life women with osteoporosis, including those with comorbidities or poorer prognosis, have a high hip fracture probability despite accounting for competing mortality risk and may still be drug treatment candidates to prevent future hip fracture.

Learn More – Primary Sources:

Association of Disease Definition, Comorbidity Burden, and Prognosis With Hip Fracture Probability Among Late-Life Women

Related ObG Topics:

The VERO Trial Results: Teriparatide vs Risedronate for the Treatment of Osteoporosis

ARCH Study Results: Does Romosozumab Prevent Fracture in Women with Osteoporosis?

The SCOOP trial: Does Osteoporosis Screening Reduce Hip Fracture Rates in Older Women?

ACP Releases Guidance Update on Osteoporosis Treatment

USPSTF Recommendations: Screening for Osteoporosis to Prevent Fractures

Osteoporosis Treatment for Postmenopausal Women at High Risk for Fracture