Fracture Risk Prediction After Age 80 Years

80 岁后骨折风险预测

基本信息

批准号：
10266823
负责人：
KRISTINE ENSRUD
金额：
$ 16.5万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-30 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10266823
关键词：
Accounting Achievement Address Adult Age Aged, 80 and over Aging Assessment tool Body Composition Bone Density Calibration Cessation of life Characteristics Chronic Clinical Cohort Studies Communities Data Discrimination Elderly Electronic Health Record Enrollment Epidemiology Equilibrium Ethnic Origin Event Fall prevention Fracture Gait speed Guidelines Health Health Status Height High Prevalence Hip Fractures Hip region structure Individual Intervention Lead Life Life Expectancy Longitudinal Studies Measurement Measures Medical Modeling Morbidity - disease rate Osteoporosis Participant Patients Performance Pharmacotherapy Phenotype Polypharmacy Population Predictive Value Prevention Prevention Measures Prevention approach Prevention strategy Probability Race Recording of previous events Risk Risk Assessment Risk Factors Role Subgroup Testing Time United States Vital Status Weight Woman aged base bone aging clinical decision-making clinical practice clinical risk cost disability experience falls fracture risk frailty functional outcomes high risk hip bone improved individual patient lifetime risk male health men middle age mortality mortality risk multiple chronic conditions osteoporosis with pathological fracture patient population patient subsets practice setting predictive modeling response risk prediction risk sharing screening secondary analysis sex tool

项目摘要

The majority of clinical fractures including hip fractures occur among adults aged 80 years and older, but there is a paucity of evidence to guide assessment of fracture risk versus competing mortality risk in this expanding patient population. Clinicians have difficulty identifying late life patients who are at highest risk of fracture since expected survival strongly impacts this risk. No currently available fracture risk assessment tool adequately addresses important issues relevant to fracture prediction in the oldest old, including selection of appropriate timeframes for fracture prediction, inclusion of key risk factors for late life fractures and mortality, and consideration of a patient's competing mortality risk given his/her set of risk factors. Our preliminary data suggests that addition of non-skeletal risk factors such as the frailty phenotype to a fracture prediction model will improve its performance in late life adults. Thus, there is a critical need for pragmatic fracture risk assessment models that better identify women and men in the 9th and 10th decades of life at high risk of fracture. Our study will combine comprehensive data collected in three large epidemiologic cohorts (Study of Osteoporotic Fractures [SOF]; Osteoporotic Fractures in Men Study [MrOS]; Health Aging and Body Composition Study [Health ABC]) to yield fracture prediction models in community-dwelling women and in men aged 80 years and older that clearly define relationships between individual and combined risk factors for fracture accounting for the competing risk of mortality and demonstrate superior performance to that of existing tools. We will generate estimates of 5-year and lifetime risks considering relevant late life non-skeletal predictors of both fracture and mortality including multimorbidity, functional limitations, polypharmacy, the frailty phenotype and its components such as shrinking, weakness and slowness. In addition, we will evaluate the role of BMD in fracture prediction including its interaction with late life non-skeletal risk factors. Valid lifetime risk assessment with adequate consideration of a patient's competing mortality risk is warranted to identify those at highest risk of fracture prior to death. In addition, a 5-year prediction time frame among these high risk patients accounting for competing mortality risk is needed for clinical decision making given the anticipated time horizon of benefit of interventions to lower fracture risk and reduced life expectancy. Successful achievement of our aims will improve clinical decision making by clearly identifying higher risk patient subgroups who should be targeted for fracture screening and prevention approaches as fracture risk is high despite consideration of competing mortality risk and lower risk subgroups where these strategies may have minimal benefit as competing risk of death far outweighs fracture risk. These results are essential to guide fracture risk assessment and shared clinical decision making in this rapidly growing segment of the US population with its high burden of shared risk factors for both fracture events and competing non-fracture related mortality.

大多数临床骨折，包括髋部骨折的年龄在80岁及以上的成年人中，但那里发生很少有证据指导骨折风险评估与竞争死亡率风险的评估患者人数。临床医生很难识别自从以来骨折风险最高的晚期患者预期生存会对这一风险产生重大影响。目前没有足够的裂缝风险评估工具解决与最古老的旧旧预测相关的重要问题，包括选择适当的裂缝预测的时间表，包括晚期生命骨折和死亡率的关键风险因素以及考虑到他/她的一系列风险因素，考虑患者的竞争死亡风险。我们的初步数据表明在断裂预测模型中添加非骨骼风险因素，例如脆弱的表型将改善其在后期成年人的表现。因此，务实的骨折风险迫切需要评估模型在9世纪和10年的生活中更好地识别男女的高风险断裂。我们的研究将结合在三个大型流行病学队列中收集的综合数据（研究骨质疏松骨折[SOF]；男性骨质疏松性骨折研究[MRO]；健康衰老和身体组成研究[健康ABC]）在社区居民和男性中产生破裂预测模型年龄80岁以上，清楚地定义了个人和合并风险因素之间的关系骨折考虑了死亡率的竞争风险，并表现出优于现有的绩效工具。考虑到相关的晚期生活，我们将产生5年和终身风险的估计骨折和死亡率的预测因素，包括多种病，功能局限性，多功能药物，脆弱性表型及其组成部分，例如缩小，无力和慢性。此外，我们将评估 BMD在断裂预测中的作用，包括其与晚期生活非骨骼风险因素的相互作用。有效的生活有必要确定风险评估，并充分考虑患者的竞争死亡风险死亡前骨折风险最高的人。此外，这些高风险中的5年预测时间范围考虑到预期的临床决策，需要考虑竞争死亡率风险的患者干预措施降低断裂风险并降低预期寿命的时间范围。成功的实现我们的目标将通过明确识别更高的风险患者来改善临床决策应该针对裂缝筛查和预防方法的亚组，因为骨折风险很高尽管考虑了竞争死亡率风险和降低这些策略的风险亚组由于死亡风险远远超过骨折风险，因此最小的好处。这些结果对于指导至关重要在美国这一快速增长的部分中，断裂风险评估和共享临床决策人口负担很高的骨折事件和竞争非骨折的共同风险因素负担相关死亡率。