What factors predict imminent fracture in older adults?

  • Sheer RL & al.
  • Am J Manag Care
  • 1 Mar 2020

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • In older adults, advanced age, female sex, and use of certain drugs predict fragility fracture risk within the next year (imminent fracture).

Why this matters

  • Breaking a bone increases mortality risk for up to 10 years thereafter.
  • Knowledge of risk factors can tailor treatment and patient education.

Study design

  • Retrospective cohort study using administrative claims data from Humana's Medicare Advantage and Prescription Drug plan for 1.287 million older US adults.
  • Analysis focused on the incidence of nontraumatic clinical fractures in the first 12 months starting in 2015.
  • Funding: None disclosed.

Key results

  • 3.8% of cohort had ≥1 fragility fracture at 12-month follow-up and 6.6% at 24 months.
  • Over the 12-month period, the following factors were associated (adjusted HRs) with having any type of fracture (all P<.0001 unless noted otherwise>
  • Recent fracture: 2.81.
  • Age 85-87 years: 2.21.
  • Age 80-84 years: 1.78.
  • Female sex: 1.46.
  • Age 75-79 years: 1.44.
  • Antidepressant/antipsychotic/sedative hypnotic/muscle relaxant medications: 1.30.
  • Respiratory disorders: 1.25.
  • Falls: 1.24.
  • White race: 1.16 (P=.0042).
  • Cerebrovascular disorders: 1.12.
  • Age 70-74 years: 1.11.

Limitations

  • Retrospective observational design.
  • Reliance on administrative claims data.