Elderly women with osteoporosis are highly likely to experience hip fracture within 5 years despite competing mortality risk and may be good candidates for drug therapy, according to study results published in JAMA Internal Medicine.
Researchers conducted this prospective cohort study of 1528 community-dwelling white women (aged ≥80 years; mean age, 84.1 years) from 4 areas in the United States to evaluate associations between 5-year hip fracture probability and disease definition, number of comorbidities, and prognosis.
Participants were assessed every 4 months for vital status, hip fracture, and presence of comorbid conditions including diabetes, stroke, and cancer. They were classified at baseline as having osteoporosis (n=761) or not having osteoporosis but being at high fracture risk (n=767). In addition, the researchers used a mortality prediction index to estimate each participant’s prognosis.
During the average follow-up of 4.4 years, 8.8% of the total population experienced a hip fracture and 18.8% died before a fracture could occur. Compared with women who did not have osteoporosis but were at high fracture risk, those with osteoporosis had a significantly higher 5-year probability of mortality (19.4% vs 24.9%, respectively). Both groups had similar increases in mortality probability with increasing comorbidities and poorer prognosis.
Conversely, 5-year hip fracture probability was 13% in women with osteoporosis and 4% in those without osteoporosis but high risk for fracture. For women with osteoporosis with ≥3 comorbid conditions, hip fracture probability was 18.1%, whereas women without osteoporosis but at high fracture risk who had ≥3 comorbid conditions had a hip fracture probability of 2.5%.
Limitations included an inability to generalize findings because of the study’s homogeneous population.
“[L]ate-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,” the researchers said, adding that the “absolute treatment benefit is likely lower among women without osteoporosis but at high fracture risk.”
Ensrud KE, Kats AM, Boyd CM, et al. Association of disease definition, comorbidity burden, and prognosis with hip fracture probability among late-life women [published online June 17, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.0682