174250 Absolute risk of fracture for decision making in osteoporotic patients: The EPIC-Norfolk population cohort study

Monday, October 27, 2008: 5:20 PM

Alireza Moayyeri, MD, MPhil , Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
Stephan Kaptoge, PhD , Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
Robert N. Luben, PhD , Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
Nicholas J. Wareham, MD, PhD , University of Cambridge, Cambridge, United Kingdom
Sheila Bingham, MD, PhD , University of Cambridge, Cambridge, United Kingdom
Kay-Tee Khaw, MD, PhD , Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
     
While estimates of relative risks associated with fracture risk factors such as age and bone mineral density (BMD) may be of interest for etiologic and comparative purposes, public health questions such as who might benefit most from preventive interventions or BMD monitoring depend on estimates of absolute fracture risk. We estimated these absolute risks in an older European population. The original cohort of the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk) study included 25,639 participants (11,607 men) aged 4079 years in 1993-1997 that were followed up for fracture outcomes up to March 2007. 10-year absolute risk of fractures for any participant were calculated using the baseline survivor function of multivariate Cox proportional-hazard models adjusting for age, sex, history of fractures, height, body mass index, smoking, and alcohol consumption. For women with and without a history of previous fracture, the 10-year absolute risk of any fracture rose from 1.6% and 0.8%, respectively, at the age of 40-44 years to 17.7% and 9.6%, respectively, at the age of 75-79 years. For men, the absolute risk rose from 1.0% to 3.0% in the youngest and oldest age groups without previous fracture and from 1.6% to 4.6% in those with previous fracture. A significant interaction observed between sex and age for prediction of fracture risk indicates that studies aiming to quantify absolute risk of fractures in older men cannot generalize the results of studies in women. The risk charts from this study can be used in development of fracture risk assessment tools for the elderly.

Learning Objectives:
1: Discuss the privileges of absolute risk estimates comparing to relative risk estimates for clinical decision making for a chronic disease 2: Describe a new statistical strategy for calculation of 10-year adjusted absolute risks for chronic diseases 3: Assess the epidemiology of osteoporotic fractures using absolute risks estimates and compare it between different populations 4: Consider different interactions (effect modifications) for prediction of absolute fracture risks and their clinical applications

Keywords: Risk Assessment, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This research is a part of my PhD project and I have gone through the stages of data acquisition and analysis, abstract preparation and final approval with co-authors of the paper. I have no conflict of interest in presenting this work.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Chronic Disease Epidemiology
See more of: Epidemiology