Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)
Identifieur interne : 000B17 ( PascalFrancis/Curation ); précédent : 000B16; suivant : 000B18Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)
Auteurs : Elaine M. Dennison [Royaume-Uni, Nouvelle-Zélande] ; Juliet E. Compston [Royaume-Uni] ; Julie Flahive [États-Unis] ; Ethel S. Siris [États-Unis] ; Stephen H. Gehlbach [États-Unis] ; Jonathan D. Adachi [Canada] ; Steven Boonen [Belgique] ; Roland Chapurlat [France] ; Adolfo Diez-Perez [Espagne] ; Frederick A. Jr Anderson [États-Unis] ; Frederick H. Hooven [États-Unis] ; Andrea Z. Lacroix [États-Unis] ; Robert Lindsay [États-Unis] ; J. Coen Netelenbos [Pays-Bas] ; Johannes Pfeilschifter [Allemagne] ; Maurizio Rossini [Italie] ; Christian Roux [France] ; Kenneth G. Saag [États-Unis] ; Philip Sambrook [Australie] ; Stuart Silverman [États-Unis] ; Nelson B. Watts [États-Unis] ; Susan L. Greenspan [États-Unis] ; Melissa Premaor ; Cyrus Cooper [Royaume-Uni]Source :
- Bone : (New York, NY) [ 8756-3282 ] ; 2012.
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- topic : Femme.
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Abstract
Introduction: Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. Materials and methods: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. Results: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% Cl: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. Conclusion: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing comorbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.
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Herriot</s1><s2>Lyon</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Diez Perez, Adolfo" sort="Diez Perez, Adolfo" uniqKey="Diez Perez A" first="Adolfo" last="Diez-Perez">Adolfo Diez-Perez</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Hospital del Mar-IMIM-Autonomous University of Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>9 aut.</sZ></inist:fA14><country>Espagne</country></affiliation></author><author><name sortKey="Anderson, Frederick A Jr" sort="Anderson, Frederick A Jr" uniqKey="Anderson F" first="Frederick A. Jr" last="Anderson">Frederick A. Jr Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Center for Outcomes Research, UMASS Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Hooven, Frederick H" sort="Hooven, Frederick H" uniqKey="Hooven F" first="Frederick H." last="Hooven">Frederick H. Hooven</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Center for Outcomes Research, UMASS Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Lacroix, Andrea Z" sort="Lacroix, Andrea Z" uniqKey="Lacroix A" first="Andrea Z." last="Lacroix">Andrea Z. Lacroix</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Fred Hutchinson Cancer Research Center</s1><s2>Seattle, WA</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Lindsay, Robert" sort="Lindsay, Robert" uniqKey="Lindsay R" first="Robert" last="Lindsay">Robert Lindsay</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Regional Bone Center, Helen Hayes Hospital</s1><s2>West Haverstraw, NY</s2><s3>USA</s3><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Coen Netelenbos, J" sort="Coen Netelenbos, J" uniqKey="Coen Netelenbos J" first="J." last="Coen Netelenbos">J. Coen Netelenbos</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Department of Endocrinology, VU University Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>14 aut.</sZ></inist:fA14><country>Pays-Bas</country></affiliation></author><author><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Alfried Krupp Krankenhaus, Department of Internal Medicine III</s1><s2>Essen</s2><s3>DEU</s3><sZ>15 aut.</sZ></inist:fA14><country>Allemagne</country></affiliation></author><author><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Department of Rheumatology, University of Verona</s1><s2>Verona</s2><s3>ITA</s3><sZ>16 aut.</sZ></inist:fA14><country>Italie</country></affiliation></author><author><name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Paris Descartes University, Cochin Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>17 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G." last="Saag">Kenneth G. Saag</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>University of Alabama-Birmingham</s1><s2>Birmingham, AL</s2><s3>USA</s3><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Sambrook, Philip" sort="Sambrook, Philip" uniqKey="Sambrook P" first="Philip" last="Sambrook">Philip Sambrook</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>University of Sydney-Royal North Shore Hospital, St. Leonards, Sydney</s1><s2>New South Wales</s2><s3>AUS</s3><sZ>19 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author><author><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>Department of Rheumatology, Cedars-Sinai/UCLA</s1><s2>Los Angeles, CA</s2><s3>USA</s3><sZ>20 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Watts, Nelson B" sort="Watts, Nelson B" uniqKey="Watts N" first="Nelson B." last="Watts">Nelson B. Watts</name><affiliation wicri:level="1"><inist:fA14 i1="19"><s1>Bone Health and Osteoporosis Center, University of Cincinnati</s1><s2>Cincinnati, OH</s2><s3>USA</s3><sZ>21 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Greenspan, Susan L" sort="Greenspan, Susan L" uniqKey="Greenspan S" first="Susan L." last="Greenspan">Susan L. Greenspan</name><affiliation wicri:level="1"><inist:fA14 i1="20"><s1>University of Pittsburgh</s1><s2>Pittsburgh, PA</s2><s3>USA</s3><sZ>22 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Premaor, Melissa" sort="Premaor, Melissa" uniqKey="Premaor M" first="Melissa" last="Premaor">Melissa Premaor</name></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital</s1><s2>Southampton</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>24 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">13-0082487</idno><date when="2012">2012</date><idno type="stanalyst">PASCAL 13-0082487 INIST</idno><idno type="RBID">Pascal:13-0082487</idno><idno type="wicri:Area/PascalFrancis/Corpus">000115</idno><idno type="wicri:Area/PascalFrancis/Curation">000B17</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)</title><author><name sortKey="Dennison, Elaine M" sort="Dennison, Elaine M" uniqKey="Dennison E" first="Elaine M." last="Dennison">Elaine M. Dennison</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital</s1><s2>Southampton</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>24 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Victoria University</s1><s2>Wellington</s2><s3>NZL</s3><sZ>1 aut.</sZ></inist:fA14><country>Nouvelle-Zélande</country></affiliation></author><author><name sortKey="Compston, Juliet E" sort="Compston, Juliet E" uniqKey="Compston J" first="Juliet E." last="Compston">Juliet E. Compston</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge</s1><s2>Cambridge</s2><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Flahive, Julie" sort="Flahive, Julie" uniqKey="Flahive J" first="Julie" last="Flahive">Julie Flahive</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Center for Outcomes Research, UMASS Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Siris, Ethel S" sort="Siris, Ethel S" uniqKey="Siris E" first="Ethel S." last="Siris">Ethel S. Siris</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Medicine, Columbia University Medical Center</s1><s2>New York, NY</s2><s3>USA</s3><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Gehlbach, Stephen H" sort="Gehlbach, Stephen H" uniqKey="Gehlbach S" first="Stephen H." last="Gehlbach">Stephen H. Gehlbach</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Center for Outcomes Research, UMASS Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Adachi, Jonathan D" sort="Adachi, Jonathan D" uniqKey="Adachi J" first="Jonathan D." last="Adachi">Jonathan D. Adachi</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>St. Joseph's Hospital, McMaster University</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>6 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Boonen, Steven" sort="Boonen, Steven" uniqKey="Boonen S" first="Steven" last="Boonen">Steven Boonen</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Leuven University Center for Metabolic Bone Diseases, Division of Geriatric Medicine, Ka<sub>th</sub>olieke Universitei<sub>t</sub> Leuven</s1><s2>Leuven</s2><s3>BEL</s3><sZ>7 aut.</sZ></inist:fA14><country>Belgique</country></affiliation></author><author><name sortKey="Chapurlat, Roland" sort="Chapurlat, Roland" uniqKey="Chapurlat R" first="Roland" last="Chapurlat">Roland Chapurlat</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>INSERM U831, Universite de Lyon, Division of Rheumatology, Hôpital E. Herriot</s1><s2>Lyon</s2><s3>FRA</s3><sZ>8 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Diez Perez, Adolfo" sort="Diez Perez, Adolfo" uniqKey="Diez Perez A" first="Adolfo" last="Diez-Perez">Adolfo Diez-Perez</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Hospital del Mar-IMIM-Autonomous University of Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>9 aut.</sZ></inist:fA14><country>Espagne</country></affiliation></author><author><name sortKey="Anderson, Frederick A Jr" sort="Anderson, Frederick A Jr" uniqKey="Anderson F" first="Frederick A. Jr" last="Anderson">Frederick A. Jr Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Center for Outcomes Research, UMASS Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Hooven, Frederick H" sort="Hooven, Frederick H" uniqKey="Hooven F" first="Frederick H." last="Hooven">Frederick H. Hooven</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Center for Outcomes Research, UMASS Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Lacroix, Andrea Z" sort="Lacroix, Andrea Z" uniqKey="Lacroix A" first="Andrea Z." last="Lacroix">Andrea Z. Lacroix</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Fred Hutchinson Cancer Research Center</s1><s2>Seattle, WA</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Lindsay, Robert" sort="Lindsay, Robert" uniqKey="Lindsay R" first="Robert" last="Lindsay">Robert Lindsay</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Regional Bone Center, Helen Hayes Hospital</s1><s2>West Haverstraw, NY</s2><s3>USA</s3><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Coen Netelenbos, J" sort="Coen Netelenbos, J" uniqKey="Coen Netelenbos J" first="J." last="Coen Netelenbos">J. Coen Netelenbos</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Department of Endocrinology, VU University Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>14 aut.</sZ></inist:fA14><country>Pays-Bas</country></affiliation></author><author><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Alfried Krupp Krankenhaus, Department of Internal Medicine III</s1><s2>Essen</s2><s3>DEU</s3><sZ>15 aut.</sZ></inist:fA14><country>Allemagne</country></affiliation></author><author><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Department of Rheumatology, University of Verona</s1><s2>Verona</s2><s3>ITA</s3><sZ>16 aut.</sZ></inist:fA14><country>Italie</country></affiliation></author><author><name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Paris Descartes University, Cochin Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>17 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G." last="Saag">Kenneth G. Saag</name><affiliation wicri:level="1"><inist:fA14 i1="16"><s1>University of Alabama-Birmingham</s1><s2>Birmingham, AL</s2><s3>USA</s3><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Sambrook, Philip" sort="Sambrook, Philip" uniqKey="Sambrook P" first="Philip" last="Sambrook">Philip Sambrook</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>University of Sydney-Royal North Shore Hospital, St. Leonards, Sydney</s1><s2>New South Wales</s2><s3>AUS</s3><sZ>19 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author><author><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name><affiliation wicri:level="1"><inist:fA14 i1="18"><s1>Department of Rheumatology, Cedars-Sinai/UCLA</s1><s2>Los Angeles, CA</s2><s3>USA</s3><sZ>20 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Watts, Nelson B" sort="Watts, Nelson B" uniqKey="Watts N" first="Nelson B." last="Watts">Nelson B. Watts</name><affiliation wicri:level="1"><inist:fA14 i1="19"><s1>Bone Health and Osteoporosis Center, University of Cincinnati</s1><s2>Cincinnati, OH</s2><s3>USA</s3><sZ>21 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Greenspan, Susan L" sort="Greenspan, Susan L" uniqKey="Greenspan S" first="Susan L." last="Greenspan">Susan L. Greenspan</name><affiliation wicri:level="1"><inist:fA14 i1="20"><s1>University of Pittsburgh</s1><s2>Pittsburgh, PA</s2><s3>USA</s3><sZ>22 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Premaor, Melissa" sort="Premaor, Melissa" uniqKey="Premaor M" first="Melissa" last="Premaor">Melissa Premaor</name></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital</s1><s2>Southampton</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>24 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author></analytic><series><title level="j" type="main">Bone : (New York, NY)</title><title level="j" type="abbreviated">Bone : (NY NY)</title><idno type="ISSN">8756-3282</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Bone : (New York, NY)</title><title level="j" type="abbreviated">Bone : (NY NY)</title><idno type="ISSN">8756-3282</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Epidemiology</term><term>Fracture</term><term>Morbidity</term><term>Morphology</term><term>Multiple sclerosis</term><term>Osteoporosis</term><term>Parkinson disease</term><term>Prognosis</term><term>Risk factor</term><term>Woman</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Epidémiologie</term><term>Morbidité</term><term>Fracture</term><term>Facteur risque</term><term>Ostéoporose</term><term>Femme</term><term>Maladie de Parkinson</term><term>Sclérose en plaques</term><term>Morphologie</term><term>Pronostic</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Femme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Introduction: Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. Materials and methods: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. Results: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% Cl: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. Conclusion: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing comorbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>8756-3282</s0></fA01><fA03 i2="1"><s0>Bone : (NY NY)</s0></fA03><fA05><s2>50</s2></fA05><fA06><s2>6</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)</s1></fA08><fA11 i1="01" i2="1"><s1>DENNISON (Elaine M.)</s1></fA11><fA11 i1="02" i2="1"><s1>COMPSTON (Juliet E.)</s1></fA11><fA11 i1="03" i2="1"><s1>FLAHIVE (Julie)</s1></fA11><fA11 i1="04" i2="1"><s1>SIRIS (Ethel S.)</s1></fA11><fA11 i1="05" i2="1"><s1>GEHLBACH (Stephen H.)</s1></fA11><fA11 i1="06" i2="1"><s1>ADACHI (Jonathan D.)</s1></fA11><fA11 i1="07" i2="1"><s1>BOONEN (Steven)</s1></fA11><fA11 i1="08" i2="1"><s1>CHAPURLAT (Roland)</s1></fA11><fA11 i1="09" i2="1"><s1>DIEZ-PEREZ (Adolfo)</s1></fA11><fA11 i1="10" i2="1"><s1>ANDERSON (Frederick A. JR)</s1></fA11><fA11 i1="11" i2="1"><s1>HOOVEN (Frederick H.)</s1></fA11><fA11 i1="12" i2="1"><s1>LACROIX (Andrea Z.)</s1></fA11><fA11 i1="13" i2="1"><s1>LINDSAY (Robert)</s1></fA11><fA11 i1="14" i2="1"><s1>COEN NETELENBOS (J.)</s1></fA11><fA11 i1="15" i2="1"><s1>PFEILSCHIFTER (Johannes)</s1></fA11><fA11 i1="16" i2="1"><s1>ROSSINI (Maurizio)</s1></fA11><fA11 i1="17" i2="1"><s1>ROUX (Christian)</s1></fA11><fA11 i1="18" i2="1"><s1>SAAG (Kenneth G.)</s1></fA11><fA11 i1="19" i2="1"><s1>SAMBROOK (Philip)</s1></fA11><fA11 i1="20" i2="1"><s1>SILVERMAN (Stuart)</s1></fA11><fA11 i1="21" i2="1"><s1>WATTS (Nelson B.)</s1></fA11><fA11 i1="22" i2="1"><s1>GREENSPAN (Susan L.)</s1></fA11><fA11 i1="23" i2="1"><s1>PREMAOR (Melissa)</s1></fA11><fA11 i1="24" i2="1"><s1>COOPER (Cyrus)</s1></fA11><fA14 i1="01"><s1>MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital</s1><s2>Southampton</s2><s3>GBR</s3><sZ>1 aut.</sZ><sZ>24 aut.</sZ></fA14><fA14 i1="02"><s1>Victoria University</s1><s2>Wellington</s2><s3>NZL</s3><sZ>1 aut.</sZ></fA14><fA14 i1="03"><s1>School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge</s1><s2>Cambridge</s2><s3>GBR</s3><sZ>2 aut.</sZ></fA14><fA14 i1="04"><s1>Center for Outcomes Research, UMASS Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>3 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></fA14><fA14 i1="05"><s1>Department of Medicine, Columbia University Medical Center</s1><s2>New York, NY</s2><s3>USA</s3><sZ>4 aut.</sZ></fA14><fA14 i1="06"><s1>St. Joseph's Hospital, McMaster University</s1><s2>Hamilton, Ontario</s2><s3>CAN</s3><sZ>6 aut.</sZ></fA14><fA14 i1="07"><s1>Leuven University Center for Metabolic Bone Diseases, Division of Geriatric Medicine, Ka<sub>th</sub>olieke Universitei<sub>t</sub> Leuven</s1><s2>Leuven</s2><s3>BEL</s3><sZ>7 aut.</sZ></fA14><fA14 i1="08"><s1>INSERM U831, Universite de Lyon, Division of Rheumatology, Hôpital E. Herriot</s1><s2>Lyon</s2><s3>FRA</s3><sZ>8 aut.</sZ></fA14><fA14 i1="09"><s1>Hospital del Mar-IMIM-Autonomous University of Barcelona</s1><s2>Barcelona</s2><s3>ESP</s3><sZ>9 aut.</sZ></fA14><fA14 i1="10"><s1>Fred Hutchinson Cancer Research Center</s1><s2>Seattle, WA</s2><s3>USA</s3><sZ>12 aut.</sZ></fA14><fA14 i1="11"><s1>Regional Bone Center, Helen Hayes Hospital</s1><s2>West Haverstraw, NY</s2><s3>USA</s3><sZ>13 aut.</sZ></fA14><fA14 i1="12"><s1>Department of Endocrinology, VU University Medical Center</s1><s2>Amsterdam</s2><s3>NLD</s3><sZ>14 aut.</sZ></fA14><fA14 i1="13"><s1>Alfried Krupp Krankenhaus, Department of Internal Medicine III</s1><s2>Essen</s2><s3>DEU</s3><sZ>15 aut.</sZ></fA14><fA14 i1="14"><s1>Department of Rheumatology, University of Verona</s1><s2>Verona</s2><s3>ITA</s3><sZ>16 aut.</sZ></fA14><fA14 i1="15"><s1>Paris Descartes University, Cochin Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>17 aut.</sZ></fA14><fA14 i1="16"><s1>University of Alabama-Birmingham</s1><s2>Birmingham, AL</s2><s3>USA</s3><sZ>18 aut.</sZ></fA14><fA14 i1="17"><s1>University of Sydney-Royal North Shore Hospital, St. Leonards, Sydney</s1><s2>New South Wales</s2><s3>AUS</s3><sZ>19 aut.</sZ></fA14><fA14 i1="18"><s1>Department of Rheumatology, Cedars-Sinai/UCLA</s1><s2>Los Angeles, CA</s2><s3>USA</s3><sZ>20 aut.</sZ></fA14><fA14 i1="19"><s1>Bone Health and Osteoporosis Center, University of Cincinnati</s1><s2>Cincinnati, OH</s2><s3>USA</s3><sZ>21 aut.</sZ></fA14><fA14 i1="20"><s1>University of Pittsburgh</s1><s2>Pittsburgh, PA</s2><s3>USA</s3><sZ>22 aut.</sZ></fA14><fA17 i1="01" i2="1"><s1>GLOW Investigators</s1><s3>INC</s3></fA17><fA20><s1>1288-1293</s1></fA20><fA21><s1>2012</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>19041</s2><s5>354000502993050110</s5></fA43><fA44><s0>0000</s0><s1>© 2013 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>41 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>13-0082487</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Bone : (New York, NY)</s0></fA64><fA66 i1="01"><s0>NLD</s0></fA66><fC01 i1="01" l="ENG"><s0>Introduction: Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. Materials and methods: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. Results: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% Cl: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. Conclusion: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing comorbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.</s0></fC01><fC02 i1="01" i2="X"><s0>002A16</s0></fC02><fC02 i1="02" i2="X"><s0>002B16H</s0></fC02><fC02 i1="03" i2="X"><s0>002B15A</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Epidémiologie</s0><s5>07</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Epidemiology</s0><s5>07</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Epidemiología</s0><s5>07</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Morbidité</s0><s5>08</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Morbidity</s0><s5>08</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Morbilidad</s0><s5>08</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Fracture</s0><s5>09</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Fracture</s0><s5>09</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Fractura</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Facteur risque</s0><s5>13</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Risk factor</s0><s5>13</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Factor riesgo</s0><s5>13</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Ostéoporose</s0><s5>14</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Osteoporosis</s0><s5>14</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Osteoporosis</s0><s5>14</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Femme</s0><s5>15</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Woman</s0><s5>15</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Mujer</s0><s5>15</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Maladie de Parkinson</s0><s2>NM</s2><s5>17</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Parkinson disease</s0><s2>NM</s2><s5>17</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s2>NM</s2><s5>17</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Sclérose en plaques</s0><s2>NM</s2><s5>18</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Multiple sclerosis</s0><s2>NM</s2><s5>18</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Esclerosis en placa</s0><s2>NM</s2><s5>18</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Morphologie</s0><s5>19</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Morphology</s0><s5>19</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Morfología</s0><s5>19</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Pronostic</s0><s5>30</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Prognosis</s0><s5>30</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Pronóstico</s0><s5>30</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Homme</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Human</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Hombre</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Pathologie du système ostéoarticulaire</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Diseases of the osteoarticular system</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema osteoarticular patología</s0><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Traumatisme</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Trauma</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Traumatismo</s0><s5>38</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie de l'encéphale</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Syndrome extrapyramidal</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>40</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>41</s5></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Pathologie du système nerveux central</s0><s5>42</s5></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>42</s5></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>42</s5></fC07><fC07 i1="08" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>43</s5></fC07><fC07 i1="08" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>43</s5></fC07><fC07 i1="08" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>43</s5></fC07><fC07 i1="09" i2="X" l="FRE"><s0>Maladie inflammatoire</s0><s5>44</s5></fC07><fC07 i1="09" i2="X" l="ENG"><s0>Inflammatory disease</s0><s5>44</s5></fC07><fC07 i1="09" i2="X" l="SPA"><s0>Enfermedad inflamatoria</s0><s5>44</s5></fC07><fN21><s1>049</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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