Joint associations of prevalent radiographic vertebral fracture and abdominal aortic calcification with incident hip, major osteoporotic, and clinical vertebral fractures
Document Type
Journal Article
Publication Title
Journal of Bone and Mineral Research
Volume
36
Issue
5
First Page
892
Last Page
900
PubMed ID
33729640
Publisher
Wiley
School
School of Medical and Health Sciences
RAS ID
39572
Funders
Funding information : https://doi.org/10.1002/jbmr.4257
Abstract
Prevalent vertebral fractures (PVFx) and abdominal aortic calcification (AAC) are both associated with incident fractures and can be ascertained on the same lateral spine images, but their joint association with incident fractures is unclear. Our objective was to estimate the individual and joint associations of PVFx and AAC with incident major osteoporotic, hip, and clinical vertebral fractures in 5365 older men enrolled in the Osteoporotic Fractures in Men (MrOS) Study, using Cox proportional hazards and Fine and Gray subdistribution hazards models to account for competing mortality. PVFx (Genant SQ grade 2 or 3) and 24-point AAC score were ascertained on baseline lateral spine radiographs. Self-reports of incident fractures were solicited every 4 months and confirmed by review of clinical radiographic reports. Compared with men without PVFx and AAC-24 score 0 or 1, the subdistribution hazard ratio (SHR) for incident major osteoporotic fracture was 1.38 (95% confidence interval [CI] 1.13–1.69) among men with AAC-24 score ≥ 2 alone, 1.71 (95% CI 1.37–2.14) for men with PVFx alone, and 2.35 (95% CI 1.75–3.16) for men with both risk factors, after accounting for conventional risk factors and competing mortality. Wald statistics showed improved prediction model performance by including both risk factors compared with including only AAC (chi-square = 17.3, p < .001) or including only PVFx (chi-square = 8.5, p =.036). Older men with both PVFx and a high level of AAC are at higher risk of incident major osteoporotic fracture than men with either risk factor alone. Assessing prevalent radiographic vertebral fracture and AAC on the same lateral spine images may improve prediction of older men who will have an incident major osteoporotic fracture, even after accounting for traditional fracture risk factors and competing mortality. © 2021 American Society for Bone and Mineral Research (ASBMR).
DOI
10.1002/jbmr.4257
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Comments
Schousboe, J. T., Langsetmo, L., Szulc, P., Lewis, J. R., Taylor, B. C., Kats, A. M., ... Ensrud, K. E. (2021). Joint associations of prevalent radiographic vertebral fracture and abdominal aortic calcification with incident hip, major osteoporotic, and clinical vertebral fractures. Journal of Bone and Mineral Research, 36(5), 892-900. https://doi.org/10.1002/jbmr.4257