TY - JOUR
T1 - Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD
T2 - A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study
AU - Harvey, Nicholas C.
AU - Odén, Anders
AU - Orwoll, Eric
AU - Lapidus, Jodi
AU - Kwok, Timothy
AU - Karlsson, Magnus K.
AU - Rosengren, Björn E.
AU - Ribom, Eva
AU - Cooper, Cyrus
AU - Cawthon, Peggy M.
AU - Kanis, John A.
AU - Ohlsson, Claes
AU - Mellström, Dan
AU - Johansson, Helena
AU - McCloskey, Eugene
N1 - Funding Information:
We thank the participants of MrOs United States, Sweden, and Hong Kong. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. MrOS Sweden is supported by the Swedish Research Council, ALF/LUA research grants in Gothenburg, and the King Gustav V and Queen Victoria Frimurarestiftelse Research Foundation. The work was also supported by the UK Medical Research Council [4050502589 (MRC LEU)]. Authors? roles: All authors contributed to manuscript drafting, review, and finalization. NCH wrote the first draft of the manuscript and oversaw its preparation; HJ and AO undertook statistical analysis; EO and JL designed and implemented MrOS US, and provided data; MK, BR, OL, CO, and DM designed and implemented MrOS Sweden, and provided data; TK designed and implemented MrOS Hong Kong, and provided data; CC contributed expertise on fracture epidemiology; EVM and JAK oversaw FRAX and provided FRAX methodology; EVM is guarantor.
Funding Information:
We thank the participants of MrOs United States, Sweden, and Hong Kong. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. MrOS Sweden is supported by the Swedish Research Council, ALF/LUA research grants in Gothenburg, and the King Gustav V and Queen Victoria Frimurarestiftelse Research Foundation. The work was also supported by the UK Medical Research Council [4050502589 (MRC LEU)].
Publisher Copyright:
© 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
PY - 2018/12
Y1 - 2018/12
N2 - Measures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for five chair stands, walking speed over a 6 m distance, grip strength, ALM adjusted for body size (ALM/height2), FRAX probability (major osteoporotic fracture [MOF]) with or without femoral neck aBMD, available in a subset of n = 7531), and incident MOF (hip, clinical vertebral, wrist, or proximal humerus). Associations were adjusted for age and time since baseline, and are reported as hazard ratios (HRs) for first incident fracture per SD increment in predictor using meta-analysis. 5660 men in the United States (mean age 73.5 years), 2764 men in Sweden (75.4 years), and 1987 men in Hong Kong (72.4 years) were studied. Mean follow-up time was 8.7 to 10.9 years. Greater time for five chair stands was associated with greater risk of MOF (HR 1.26; 95% CI, 1.19 to 1.34), whereas greater walking speed (HR 0.85; 95% CI, 0.79 to 0.90), grip strength (HR 0.77; 95% CI, 0.72 to 0.82), and ALM/height2 (HR 0.85; 95% CI, 0.80 to 0.90) were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but associations between ALM/height2 and MOF were weakened (HR 0.92; 95% CI, 0.85 to 0.99). Inclusion of femoral neck aBMD markedly attenuated the association between ALM/height2 and MOF (HR 1.02; 95% CI, 0.96 to 1.10). Measures of physical performance predicted incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height2 was substantially reduced by inclusion of aBMD requires further study, these findings support the consideration of physical performance in fracture risk assessment.
AB - Measures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for five chair stands, walking speed over a 6 m distance, grip strength, ALM adjusted for body size (ALM/height2), FRAX probability (major osteoporotic fracture [MOF]) with or without femoral neck aBMD, available in a subset of n = 7531), and incident MOF (hip, clinical vertebral, wrist, or proximal humerus). Associations were adjusted for age and time since baseline, and are reported as hazard ratios (HRs) for first incident fracture per SD increment in predictor using meta-analysis. 5660 men in the United States (mean age 73.5 years), 2764 men in Sweden (75.4 years), and 1987 men in Hong Kong (72.4 years) were studied. Mean follow-up time was 8.7 to 10.9 years. Greater time for five chair stands was associated with greater risk of MOF (HR 1.26; 95% CI, 1.19 to 1.34), whereas greater walking speed (HR 0.85; 95% CI, 0.79 to 0.90), grip strength (HR 0.77; 95% CI, 0.72 to 0.82), and ALM/height2 (HR 0.85; 95% CI, 0.80 to 0.90) were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but associations between ALM/height2 and MOF were weakened (HR 0.92; 95% CI, 0.85 to 0.99). Inclusion of femoral neck aBMD markedly attenuated the association between ALM/height2 and MOF (HR 1.02; 95% CI, 0.96 to 1.10). Measures of physical performance predicted incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height2 was substantially reduced by inclusion of aBMD requires further study, these findings support the consideration of physical performance in fracture risk assessment.
KW - EPIDEMIOLOGY
KW - FALLS
KW - FRACTURE
KW - FRAX
KW - INTERACTION
KW - OSTEOPOROSIS
UR - http://www.scopus.com/inward/record.url?scp=85052802988&partnerID=8YFLogxK
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U2 - 10.1002/jbmr.3556
DO - 10.1002/jbmr.3556
M3 - Article
C2 - 30011086
AN - SCOPUS:85052802988
VL - 33
SP - 2150
EP - 2157
JO - Journal of Bone and Mineral Research
JF - Journal of Bone and Mineral Research
SN - 0884-0431
IS - 12
ER -