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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">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><nlm:aff id="A1">MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK and Victoria University, Wellington, New Zealand</nlm:aff></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><nlm:aff id="A2">School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK</nlm:aff></affiliation></author><author><name sortKey="Flahive, Julie" sort="Flahive, Julie" uniqKey="Flahive J" first="Julie" last="Flahive">Julie Flahive</name><affiliation><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff id="A4">Department of Medicine, Columbia University Medical Center, New York, NY, USA</nlm:aff></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><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff id="A5">St. Joseph’s Hospital, McMaster University, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Boonen, Steven" sort="Boonen, Steven" uniqKey="Boonen S" first="Steven" last="Boonen">Steven Boonen</name><affiliation><nlm:aff id="A6">Leuven University Center for Metabolic Bone Diseases, Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium</nlm:aff></affiliation></author><author><name sortKey="Chapurlat, Roland" sort="Chapurlat, Roland" uniqKey="Chapurlat R" first="Roland" last="Chapurlat">Roland Chapurlat</name><affiliation><nlm:aff id="A7">INSERM U831, Université de Lyon, Division of Rheumatology, Hôpital E. Herriot, Lyon, France</nlm:aff></affiliation></author><author><name sortKey="Diez Perez, Adolfo" sort="Diez Perez, Adolfo" uniqKey="Diez Perez A" first="Adolfo" last="Díez-Pérez">Adolfo Díez-Pérez</name><affiliation><nlm:aff id="A8">Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><affiliation><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lindsay, Robert" sort="Lindsay, Robert" uniqKey="Lindsay R" first="Robert" last="Lindsay">Robert Lindsay</name><affiliation><nlm:aff id="A10">Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY, USA</nlm:aff></affiliation></author><author><name sortKey="Netelenbos, J Coen" sort="Netelenbos, J Coen" uniqKey="Netelenbos J" first="J. Coen" last="Netelenbos">J. Coen Netelenbos</name><affiliation><nlm:aff id="A11">Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands</nlm:aff></affiliation></author><author><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name><affiliation><nlm:aff id="A12">Alfried Krupp Krankenhaus, Department of Internal Medicine III, Essen, Germany</nlm:aff></affiliation></author><author><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name><affiliation><nlm:aff id="A13">Department of Rheumatology, University of Verona, Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name><affiliation><nlm:aff id="A14">Paris Descartes University, Cochin Hospital, Paris, France</nlm:aff></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><nlm:aff id="A15">University of Alabama-Birmingham, Birmingham, AL, USA</nlm:aff></affiliation></author><author><name sortKey="Sambrook, Philip" sort="Sambrook, Philip" uniqKey="Sambrook P" first="Philip" last="Sambrook">Philip Sambrook</name><affiliation><nlm:aff id="A16">University of Sydney-Royal North Shore Hospital, St. Leonards, Sydney, New South Wales, Australia</nlm:aff></affiliation></author><author><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name><affiliation><nlm:aff id="A17">Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, CA, USA</nlm:aff></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><nlm:aff id="A18">Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, OH, USA</nlm:aff></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><nlm:aff id="A19">University of Pittsburgh, Pittsburgh, PA, USA</nlm:aff></affiliation></author><author><name sortKey="Premaor, Melissa" sort="Premaor, Melissa" uniqKey="Premaor M" first="Melissa" last="Premaor">Melissa Premaor</name><affiliation><nlm:aff id="A20">School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK</nlm:aff></affiliation></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation><nlm:aff id="A21">Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK and MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22426498</idno><idno type="pmc">4886309</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4886309</idno><idno type="RBID">PMC:4886309</idno><idno type="doi">10.1016/j.bone.2012.02.639</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">000641</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000641</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">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><nlm:aff id="A1">MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK and Victoria University, Wellington, New Zealand</nlm:aff></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><nlm:aff id="A2">School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK</nlm:aff></affiliation></author><author><name sortKey="Flahive, Julie" sort="Flahive, Julie" uniqKey="Flahive J" first="Julie" last="Flahive">Julie Flahive</name><affiliation><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff id="A4">Department of Medicine, Columbia University Medical Center, New York, NY, USA</nlm:aff></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><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff id="A5">St. Joseph’s Hospital, McMaster University, Hamilton, Ontario, Canada</nlm:aff></affiliation></author><author><name sortKey="Boonen, Steven" sort="Boonen, Steven" uniqKey="Boonen S" first="Steven" last="Boonen">Steven Boonen</name><affiliation><nlm:aff id="A6">Leuven University Center for Metabolic Bone Diseases, Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium</nlm:aff></affiliation></author><author><name sortKey="Chapurlat, Roland" sort="Chapurlat, Roland" uniqKey="Chapurlat R" first="Roland" last="Chapurlat">Roland Chapurlat</name><affiliation><nlm:aff id="A7">INSERM U831, Université de Lyon, Division of Rheumatology, Hôpital E. Herriot, Lyon, France</nlm:aff></affiliation></author><author><name sortKey="Diez Perez, Adolfo" sort="Diez Perez, Adolfo" uniqKey="Diez Perez A" first="Adolfo" last="Díez-Pérez">Adolfo Díez-Pérez</name><affiliation><nlm:aff id="A8">Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain</nlm:aff></affiliation></author><author><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><affiliation><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff id="A3">Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</nlm:aff></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><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Lindsay, Robert" sort="Lindsay, Robert" uniqKey="Lindsay R" first="Robert" last="Lindsay">Robert Lindsay</name><affiliation><nlm:aff id="A10">Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY, USA</nlm:aff></affiliation></author><author><name sortKey="Netelenbos, J Coen" sort="Netelenbos, J Coen" uniqKey="Netelenbos J" first="J. Coen" last="Netelenbos">J. Coen Netelenbos</name><affiliation><nlm:aff id="A11">Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands</nlm:aff></affiliation></author><author><name sortKey="Pfeilschifter, Johannes" sort="Pfeilschifter, Johannes" uniqKey="Pfeilschifter J" first="Johannes" last="Pfeilschifter">Johannes Pfeilschifter</name><affiliation><nlm:aff id="A12">Alfried Krupp Krankenhaus, Department of Internal Medicine III, Essen, Germany</nlm:aff></affiliation></author><author><name sortKey="Rossini, Maurizio" sort="Rossini, Maurizio" uniqKey="Rossini M" first="Maurizio" last="Rossini">Maurizio Rossini</name><affiliation><nlm:aff id="A13">Department of Rheumatology, University of Verona, Verona, Italy</nlm:aff></affiliation></author><author><name sortKey="Roux, Christian" sort="Roux, Christian" uniqKey="Roux C" first="Christian" last="Roux">Christian Roux</name><affiliation><nlm:aff id="A14">Paris Descartes University, Cochin Hospital, Paris, France</nlm:aff></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><nlm:aff id="A15">University of Alabama-Birmingham, Birmingham, AL, USA</nlm:aff></affiliation></author><author><name sortKey="Sambrook, Philip" sort="Sambrook, Philip" uniqKey="Sambrook P" first="Philip" last="Sambrook">Philip Sambrook</name><affiliation><nlm:aff id="A16">University of Sydney-Royal North Shore Hospital, St. Leonards, Sydney, New South Wales, Australia</nlm:aff></affiliation></author><author><name sortKey="Silverman, Stuart" sort="Silverman, Stuart" uniqKey="Silverman S" first="Stuart" last="Silverman">Stuart Silverman</name><affiliation><nlm:aff id="A17">Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, CA, USA</nlm:aff></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><nlm:aff id="A18">Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, OH, USA</nlm:aff></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><nlm:aff id="A19">University of Pittsburgh, Pittsburgh, PA, USA</nlm:aff></affiliation></author><author><name sortKey="Premaor, Melissa" sort="Premaor, Melissa" uniqKey="Premaor M" first="Melissa" last="Premaor">Melissa Premaor</name><affiliation><nlm:aff id="A20">School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK</nlm:aff></affiliation></author><author><name sortKey="Cooper, Cyrus" sort="Cooper, Cyrus" uniqKey="Cooper C" first="Cyrus" last="Cooper">Cyrus Cooper</name><affiliation><nlm:aff id="A21">Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK and MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK</nlm:aff></affiliation></author></analytic><series><title level="j">Bone</title><idno type="ISSN">8756-3282</idno><idno type="eISSN">1873-2763</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Introduction</title><p id="P1">Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX.</p></sec><sec id="S2"><title>Materials and methods</title><p id="P2">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.</p></sec><sec id="S3"><title>Results</title><p id="P3">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% CI: 1.6–3.1; <italic>P</italic><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.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">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 co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8504048</journal-id><journal-id journal-id-type="pubmed-jr-id">1710</journal-id><journal-id journal-id-type="nlm-ta">Bone</journal-id><journal-id journal-id-type="iso-abbrev">Bone</journal-id><journal-title-group><journal-title>Bone</journal-title></journal-title-group><issn pub-type="ppub">8756-3282</issn><issn pub-type="epub">1873-2763</issn></journal-meta><article-meta><article-id pub-id-type="pmid">22426498</article-id><article-id pub-id-type="pmc">4886309</article-id><article-id pub-id-type="doi">10.1016/j.bone.2012.02.639</article-id><article-id pub-id-type="manuscript">NIHMS786585</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Dennison</surname><given-names>Elaine M.</given-names></name><xref ref-type="aff" rid="A1">a</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Compston</surname><given-names>Juliet E.</given-names></name><xref ref-type="aff" rid="A2">b</xref></contrib><contrib contrib-type="author"><name><surname>Flahive</surname><given-names>Julie</given-names></name><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Siris</surname><given-names>Ethel S.</given-names></name><xref ref-type="aff" rid="A4">d</xref></contrib><contrib contrib-type="author"><name><surname>Gehlbach</surname><given-names>Stephen H.</given-names></name><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Adachi</surname><given-names>Jonathan D.</given-names></name><xref ref-type="aff" rid="A5">e</xref></contrib><contrib contrib-type="author"><name><surname>Boonen</surname><given-names>Steven</given-names></name><xref ref-type="aff" rid="A6">f</xref></contrib><contrib contrib-type="author"><name><surname>Chapurlat</surname><given-names>Roland</given-names></name><xref ref-type="aff" rid="A7">g</xref></contrib><contrib contrib-type="author"><name><surname>Díez-Pérez</surname><given-names>Adolfo</given-names></name><xref ref-type="aff" rid="A8">h</xref></contrib><contrib contrib-type="author"><name><surname>Anderson</surname><given-names>Frederick A.</given-names><suffix>Jr</suffix></name><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>Hooven</surname><given-names>Frederick H.</given-names></name><xref ref-type="aff" rid="A3">c</xref></contrib><contrib contrib-type="author"><name><surname>LaCroix</surname><given-names>Andrea Z.</given-names></name><xref ref-type="aff" rid="A9">i</xref></contrib><contrib contrib-type="author"><name><surname>Lindsay</surname><given-names>Robert</given-names></name><xref ref-type="aff" rid="A10">j</xref></contrib><contrib contrib-type="author"><name><surname>Netelenbos</surname><given-names>J. Coen</given-names></name><xref ref-type="aff" rid="A11">k</xref></contrib><contrib contrib-type="author"><name><surname>Pfeilschifter</surname><given-names>Johannes</given-names></name><xref ref-type="aff" rid="A12">l</xref></contrib><contrib contrib-type="author"><name><surname>Rossini</surname><given-names>Maurizio</given-names></name><xref ref-type="aff" rid="A13">m</xref></contrib><contrib contrib-type="author"><name><surname>Roux</surname><given-names>Christian</given-names></name><xref ref-type="aff" rid="A14">n</xref></contrib><contrib contrib-type="author"><name><surname>Saag</surname><given-names>Kenneth G.</given-names></name><xref ref-type="aff" rid="A15">o</xref></contrib><contrib contrib-type="author"><name><surname>Sambrook</surname><given-names>Philip</given-names></name><xref ref-type="aff" rid="A16">p</xref></contrib><contrib contrib-type="author"><name><surname>Silverman</surname><given-names>Stuart</given-names></name><xref ref-type="aff" rid="A17">q</xref></contrib><contrib contrib-type="author"><name><surname>Watts</surname><given-names>Nelson B.</given-names></name><xref ref-type="aff" rid="A18">r</xref></contrib><contrib contrib-type="author"><name><surname>Greenspan</surname><given-names>Susan L.</given-names></name><xref ref-type="aff" rid="A19">s</xref></contrib><contrib contrib-type="author"><name><surname>Premaor</surname><given-names>Melissa</given-names></name><xref ref-type="aff" rid="A20">t</xref></contrib><contrib contrib-type="author"><name><surname>Cooper</surname><given-names>Cyrus</given-names></name><xref ref-type="aff" rid="A21">u</xref></contrib><contrib contrib-type="author"><collab>for the GLOW Investigators</collab></contrib></contrib-group><aff id="A1"><label>a</label>MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK and Victoria University, Wellington, New Zealand</aff><aff id="A2"><label>b</label>School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK</aff><aff id="A3"><label>c</label>Center for Outcomes Research, UMASS Medical School, Worcester, MA, USA</aff><aff id="A4"><label>d</label>Department of Medicine, Columbia University Medical Center, New York, NY, USA</aff><aff id="A5"><label>e</label>St. Joseph’s Hospital, McMaster University, Hamilton, Ontario, Canada</aff><aff id="A6"><label>f</label>Leuven University Center for Metabolic Bone Diseases, Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium</aff><aff id="A7"><label>g</label>INSERM U831, Université de Lyon, Division of Rheumatology, Hôpital E. Herriot, Lyon, France</aff><aff id="A8"><label>h</label>Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain</aff><aff id="A9"><label>I</label>Fred Hutchinson Cancer Research Center, Seattle, WA, USA</aff><aff id="A10"><label>j</label>Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY, USA</aff><aff id="A11"><label>k</label>Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands</aff><aff id="A12"><label>l</label>Alfried Krupp Krankenhaus, Department of Internal Medicine III, Essen, Germany</aff><aff id="A13"><label>m</label>Department of Rheumatology, University of Verona, Verona, Italy</aff><aff id="A14"><label>n</label>Paris Descartes University, Cochin Hospital, Paris, France</aff><aff id="A15"><label>o</label>University of Alabama-Birmingham, Birmingham, AL, USA</aff><aff id="A16"><label>p</label>University of Sydney-Royal North Shore Hospital, St. Leonards, Sydney, New South Wales, Australia</aff><aff id="A17"><label>q</label>Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, CA, USA</aff><aff id="A18"><label>r</label>Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, OH, USA</aff><aff id="A19"><label>s</label>University of Pittsburgh, Pittsburgh, PA, USA</aff><aff id="A20"><label>t</label>School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK</aff><aff id="A21"><label>u</label>Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK and MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK</aff><author-notes><corresp id="cor1"><label>*</label>Corresponding author. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK. Tel: +44 2380 777624; Fax: +44 2380 704021. <email>emd@mrc.soton.ac.uk</email> (E.M. Dennison)</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>14</day><month>5</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>09</day><month>3</month><year>2012</year></pub-date><pub-date pub-type="ppub"><month>6</month><year>2012</year></pub-date><pub-date pub-type="pmc-release"><day>31</day><month>5</month><year>2016</year></pub-date><volume>50</volume><issue>6</issue><fpage>1288</fpage><lpage>1293</lpage><pmc-comment>elocation-id from pubmed: 10.1016/j.bone.2012.02.639</pmc-comment>
<abstract><sec id="S1"><title>Introduction</title><p id="P1">Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX.</p></sec><sec id="S2"><title>Materials and methods</title><p id="P2">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.</p></sec><sec id="S3"><title>Results</title><p id="P3">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% CI: 1.6–3.1; <italic>P</italic><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.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">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 co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.</p></sec></abstract><kwd-group><kwd>Fracture risk</kwd><kwd>Co-morbidities</kwd><kwd>Parkinson’s disease</kwd><kwd>Multiple sclerosis</kwd><kwd>FRAX</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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