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Pluskiewicz W, Werner A, Bach M, Adamczyk P, Drozdzowska B. Fracture risk prediction in postmenopausal women from GO Study: the comparison between FRAX, Garvan, and POL-RISK algorithms. Arch Osteoporos 2024; 19:39. [PMID: 38755326 PMCID: PMC11098877 DOI: 10.1007/s11657-024-01392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/21/2024] [Indexed: 05/18/2024]
Abstract
In the longitudinal, retrospective study, the ability of the FRAX, Garvan, and POL-RISK algorithms to predict osteoporotic fractures was compared in a group of 457 women. Using the rigid threshold of 10% showed a significant discrepancy in sensitivity and specificity of all tools. New thresholds for high risk of fractures were established for each calculator separately: 6.3% for FRAX major fracture, 20.0% for Garvan any fracture, and 18.0% for POL-RISK any fracture. Such thresholds allow for improving the diagnostic accuracy of all three calculators. INTRODUCTION The aim of the longitudinal, retrospective study was to compare three tools designed to assess fracture risk: FRAX, Garvan, and POL-RISK in their prediction of fracture incidence. MATERIAL The study group consisted of 457 postmenopausal women with a mean age of 64.21 ± 5.94 years from the Gliwice Osteoporosis (GO) Study. Comprehensive data on clinical factors related to fractures were collected for all participants. Bone densitometry was performed at the proximal femur using the Prodigy device (GE, USA). Fracture risk was established using the FRAX, Garvan, and POL-RISK algorithms. Data on the incidence of osteoporotic fractures were collected over the last 10 years. RESULTS During the period of observation 72, osteoporotic fractures occurred in 63 subjects. For a preliminary comparison of the predictive value of analyzed diagnostic tools, the fracture risk threshold of 10% was used. For FRAX, the fracture probability exceeding 10% was observed only in 11 subjects who experienced fractures; thus, the fracture was properly predicted only in 22.9% of women. For Garvan, the respective value was 90.5%, and for POL-RISK, it was 98.4%. That gave a very low true positive value for FRAX and a very high false positive value for Garvan and POL-RISK. Based on ROC curves, new thresholds for high risk of fractures were established for each calculator separately: 6.3% for FRAX major fracture, 20.0% for Garvan any fracture, and 18.0% for POL-RISK any fracture. Such thresholds improve the diagnostic accuracy of all compared fracture prediction tools. CONCLUSION The current study showed that different fracture risk assessment tools, although having similar clinical purposes, require different cut-off thresholds for making therapeutic decisions. Better identification of patients requiring therapy based on such an approach may help reduce the number of new fractures.
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Affiliation(s)
- W Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 3-Maja 13/15 Street, 41-800, Katowice, Poland.
| | - A Werner
- Department of Applied Informatics, Silesian University of Technology, 44-100, Gliwice, Poland
| | - M Bach
- Department of Applied Informatics, Silesian University of Technology, 44-100, Gliwice, Poland
| | - P Adamczyk
- Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - B Drozdzowska
- Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Pluskiewicz W, Adamczyk P, Werner A, Bach M, Drozdzowska B. Height Loss Is an Independent Predictor of Fracture Incidence in Postmenopausal Women: The Results from the Gliwice Osteoporosis Study (GO Study). Biomedicines 2023; 11:2231. [PMID: 37626729 PMCID: PMC10452816 DOI: 10.3390/biomedicines11082231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The aim of a longitudinal, retrospective study was to establish variables predicting fracture incidence over a decade. METHODS The study sample comprises a group of 457 postmenopausal women aged over 55 years, recruited from the database of an outpatient osteoporotic clinic. Several variables with potential influence on bone status, including the measurement of body height and hip bone densitometry, were collected. BMD at the femoral neck (FN BMD) was established using a Prodigy device (Lunar, GE, USA). Current body height was compared with the maximal historical body height in early adulthood, as reported by the patient. RESULTS Three hundred and ninety-four women did not have fractures during the follow up, and 63 subjects presented fractures. Subjects with fracture had lower FN BMD with a T-score of -1.86 ± 1.04 compared to -1.44 ± 0.89 in those without fractures (p < 0.001). Mean height loss (HL) was 3.47 ± 2.11 cm in fractured subjects and 2.50 ± 2.47 cm in unfractured ones, and differed significantly, p < 0.01. Fracture incidence was significantly related to age, rheumatoid arthritis, falls, and previous fractures. In the multivariable analysis using logistic regression, FN BMD, baseline fracture, and HL were identified as the significant predictors of fractures of follow up. CONCLUSIONS Osteoporotic fractures in postmenopausal women were predicted by FN BMD, prior fracture(s), and HL easily established during physical examination.
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Affiliation(s)
- Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Piotr Adamczyk
- Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Aleksandra Werner
- Department of Applied Informatics, Silesian University of Technology, 44-100 Gliwice, Poland; (A.W.); (M.B.)
| | - Małgorzata Bach
- Department of Applied Informatics, Silesian University of Technology, 44-100 Gliwice, Poland; (A.W.); (M.B.)
| | - Bogna Drozdzowska
- Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
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Natarajan Gavriilidou N, Jonasson G, Sundh V, Rothenberg E, Lissner L. Does mandibular bone structure predict subsequent height loss? A longitudinal cohort study of women in Gothenburg, Sweden. BMJ Open 2023; 13:e066844. [PMID: 37402521 PMCID: PMC10391805 DOI: 10.1136/bmjopen-2022-066844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Several risk factors for loss of height with increasing age have been identified. OBJECTIVE To investigate if mandibular bone structure predicts future height loss in middle-aged and elderly Swedish women. DESIGN Prospective cohort study with longitudinally measured heights, radiographical assessments of the cortical bone using Klemetti's Index (normal, moderate or severely eroded cortex) and classification of the trabecular bone using an index proposed by Lindh et al (sparse, mixed or dense trabeculation). No intervention was performed. SETTING Gothenburg, Sweden. PARTICIPANTS A population-based sample of 937 Swedish women born in 1914, 1922 and 1930 was recruited. At the baseline examination, the ages were 38, 46 and 54 years. All had undergone a dental examination with panoramic radiographs of the mandible, and a general examination including height measurements on at least two occasions. MAIN OUTCOME MEASURE Height loss was calculated over three periods 12-13 years (1968-1980, 1980-1992, 1992-2005). MAIN RESULTS Mean annual height loss measures were 0.075 cm/year, 0.08 cm/year and 0.18 cm/year over the three observation intervals, corresponding to absolute decreases of 0.9 cm, 1.0 cm and 2.4 cm. Cortical erosion in 1968, 1980 and 1992 significantly predicted height loss 12 years later. Sparse trabeculation in 1968, 1980 and 1992 also predicted significant shrinkage over 12 or 13 years. Multivariable regression analyses adjusting for baseline covariates such as height, birth year, physical activity, smoking, body mass index and education yielded consistent findings except for cortical erosion 1968-1980. CONCLUSION Mandibular bone structure characteristics such as severe cortical erosion and sparse trabeculation may serve as early risk factors for height loss. Since most individuals visit their dentist at least every 2 years and radiographs are taken, a collaboration between dentists and physicians may open opportunities for predicting future risk of height loss.
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Affiliation(s)
| | - Grethe Jonasson
- Department of Behavioral and Community Dentistry, University of Gothenburg, Gothenburg, Sweden
| | - Valter Sundh
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Pluskiewicz W, Pietraszkiewicz F. Letter to the editor. Osteoporos Int 2022; 33:2229-2230. [PMID: 35925261 DOI: 10.1007/s00198-022-06515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 3-Maja 13/15 street, 41-800, Zabrze, Poland.
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Schäppi J, Stringhini S, Guessous I, Staub K, Matthes KL. Body height in adult women and men in a cross-sectional population-based survey in Geneva: temporal trends, association with general health status and height loss after age 50. BMJ Open 2022; 12:e059568. [PMID: 35803618 PMCID: PMC9272122 DOI: 10.1136/bmjopen-2021-059568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE On the one hand, trends in average height in adulthood mirror changes in living standard and health status of a population and its subgroups; on the other hand, height in general, as well as the loss of height in older age in particular, are associated in different ways with outcomes for health. For these aspects, there is hardly any information for Switzerland based on representative and measured body height data. DESIGN Repeated cross-sectional survey study. SETTING Fully anonymised data from the representative population-based Geneva Bus Santé Study between 2005 and 2017 were analysed. METHODS Data from N=8686 study participants were used in the trend analysis. Height was measured and sociodemographic information and self-rated health was collected via questionnaires. Follow-up (mean: 7.1 years) measurements from N=2112 participants were available to assess height loss after age 50. RESULTS Women were, on average, 166.2 cm (SD 6.5) tall and men 179.2 cm (SD 6.5). Among men and women, higher socioeconomic status was associated with taller average height. The flattening of the increase in height from the 1970s birth years appears to begin earlier in the subgroup with the highest education level. The tallest average height was measured for men and women from Central and Northern Europe, the shortest for South America and Asia. The likelihood that participants rated their health as 'very good' increased with greater body height. The follow-up data show that men lost -0.11 cm per follow-up year (95% CI -0.12 to -0.10), women -0.17 cm (95% CI -0.18 to 0.15). CONCLUSIONS The association of height and health status is currently understudied. Monitoring changes in average body height may indicate disparities in different subgroups of populations. Based on our study and a growing literature, we think that the multifaceted role of body height should be better considered in clinical practice.
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Affiliation(s)
- Julia Schäppi
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Hôpitaux Universitaires Genève, Geneve, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Idris Guessous
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Kaspar Staub
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
- Swiss School of Public Health SSPH+, Zurich, Switzerland
| | - Katarina L Matthes
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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Pluskiewicz W, Adamczyk P, Drozdzowska B. Glucocorticoids Increase Fracture Risk and Fracture Prevalence Independently from Bone Mineral Density and Clinical Risk Factors: Results from the Gliwice Osteoporosis (GO) Study. Horm Metab Res 2022; 54:20-24. [PMID: 34986496 DOI: 10.1055/a-1700-5007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The aim of the study was to establish the influence of glucocorticoids (GC) on fracture risk, probability, and prevalence. A set of 1548 postmenopausal women were divided into study group - treated with GC (n=114, age 66.48±7.6 years) and controls (n=1434, age 66.46±6.83 years). Data on clinical risk factors for osteoporosis and fractures were collected. Hip bone densitometry was performed using a device Prodigy (GE, USA). Fracture probability was established by FRAX, and fracture risk by Garvan algorithm and POL-RISK. Fracture risk and fracture probability were significantly greater for GC-treated women in comparison to controls. In the study group, there were 24, 3, 24, and 6 fractures noted at spine, hip, forearm, and arm, respectively. The respective numbers of fractures reported in controls at those skeletal sites were: 186, 23, 240, and 25. The use of GCs increased significantly prevalence of all major, spine and arm fractures. Also the number of all fractures was affected by GC use. Following factors significantly increased fracture probability: age (OR 1.04 per each year; 95% CI: 1.03-1.06), GC use (OR 1.54; 95% CI: 1.03-2.31), falls (OR 2.09; 95% CI: 1.60-2.73), and FN T-score (OR 0.62 per each unit; 95% CI: 0.54-0.71). In conclusion, in patients treated with GCs the fracture risk, probability, and prevalence were increased. This effect was evident regardless of whether GC therapy is included in the algorithm as a risk factor (FRAX, POL-RISK) or not taken into consideration (Garvan nomogram).
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Affiliation(s)
- Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Adamczyk
- Department of Paediatrcs, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Bogna Drozdzowska
- Department of Pathomorfology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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Pluskiewicz W, Adamczyk P, Drozdzowska B. Height loss in postmenopausal women-do we need more for fracture risk assessment? Results from the GO Study. Osteoporos Int 2021; 32:2043-2049. [PMID: 33818635 PMCID: PMC8510894 DOI: 10.1007/s00198-021-05941-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/25/2021] [Indexed: 01/01/2023]
Abstract
UNLABELLED Human body height loss of 3-4 cm or more may be considered a simple indicator of increasing fracture risk, where the information is very similar to the results from fracture risk assessments by available online calculators, all of them based on a multiple variable approaches. INTRODUCTION The aim of the study was to assess the relationship between body height loss (HL) and fracture risk in postmenopausal women from the Gliwice Osteoporosis (GO) Study. METHODS The study sample included 1735 postmenopausal women, aged over 55 years and recruited at the Osteoporotic Outpatient Clinic. The mean age of the study participants was 68.15 ± 8.16 years. Fracture risk was established, using the fracture risk assessment tool (FRAX) (10-year probability of major and hip fractures), the Garvan calculator (any and hip fractures, 5 and 10 years) and the Polish (POL-RISK) algorithm, available at www. fracture - risk .pl (any fractures, 5 years). Bone densitometry at the femoral neck was performed, using a Prodigy device (Lunar, GE, USA). Body heights were measured before bone densitometry, using a wall stadiometer and compared with the maximum body heights, measured in early adulthood and reported by the study participants themselves. RESULTS In 199 women, the body heights, measured during the study, did not change in comparison to their corresponding values in early adulthood, while being decreased in the other 1536 women. The mean height loss (HL) in the whole study group was 3.95 ± 3.24 cm. That HL correlated significantly with the calculated fracture risk (the r range from 0.13 to 0.39, p < 0.0001). In general, regarding the patients with fracture risk close to the recommended therapeutic thresholds, HL was around 3-4 cm, except of the values from the FRAX calculator for major fractures, where the commonly used therapeutic threshold (20%) was related to HL of approximately 6.5 cm. In subjects with HL between 3.5 and 4 cm (n = 208), the FRAX value for major fractures was 6.83 ± 3.74. CONCLUSIONS Body height measurements, carried out to establish HL, provide an important information for clinical practice, where HL of 3-4 cm or more may be considered a simple indicator of increasing fracture risk.
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Affiliation(s)
- W Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology, and Nephrology, Metabolic Bone Diseases Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 3-Maja 13/15 Street, 41-800 Zabrze, Katowice, Poland.
| | - P Adamczyk
- Department of Pediatrics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - B Drozdzowska
- Department of Pathomorphology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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