A E Litwic1, J E Compston2, A Wyman3, E S Siris4, S H Gehlbach3, J D Adachi5, R Chapurlat6, A Díez-Pérez7, A Z LaCroix8, J W Nieves9, J C Netelenbos10, J Pfeilschifter11, M Rossini12, C Roux13, K G Saag14, S Silverman15, N B Watts16, S L Greenspan17, L March18, C L Gregson1,19, C Cooper1,20, E M Dennison21. 1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK. 2. Cambridge Biomedical Centre, Cambridge, UK. 3. Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA. 4. Department of Medicine, Columbia University Medical Center, New York, NY, USA. 5. St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada. 6. INSERM U831, Division of Rheumatology, Hôpital E. Herriot, Université de Lyon, Lyon, France. 7. Hospital del Mar-IMIM-Autonomous, University of Barcelona, Barcelona, Spain. 8. Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 9. Helen Hayes Hospital and Columbia University, West Haverstraw, NY, USA. 10. Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands. 11. Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany. 12. Department of Rheumatology, University of Verona, Verona, Italy. 13. Cochin Hospital, Paris Descartes University, Paris, France. 14. University of Alabama-Birmingham, Birmingham, AL, USA. 15. Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, CA, USA. 16. Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, OH, USA. 17. University of Pittsburgh, Pittsburgh, PA, USA. 18. Faculty of Medicine and Department of Public Health, University of Sydney, Sydney, Australia. 19. Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol, Bristol, UK. 20. Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK. 21. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK. emd@mrc.soton.ac.uk.
Abstract
In this study, we report that self-perception of fracture risk captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is associated with improved medication uptake. It suggests that adequate appreciation of fracture risk may be beneficial and lead to greater healthcare engagement and treatment. INTRODUCTION: This study aimed to assess how well self-perception of fracture risk, and fracture risk as estimated by the fracture prediction tool FRAX, related to fracture incidence and uptake and persistence of anti-osteoporosis medication among women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). METHODS: GLOW is an international cohort study involving 723 physician practices across 10 countries in Europe, North America and Australia. Aged ≥ 55 years, 60,393 women completed baseline questionnaires detailing medical history, including co-morbidities, fractures and self-perceived fracture risk (SPR). Annual follow-up included self-reported incident fractures and anti-osteoporosis medication (AOM) use. We calculated FRAX risk without bone mineral density measurement. RESULTS: Of the 39,241 women with at least 1 year of follow-up data, 2132 (5.4%) sustained an incident major osteoporotic fracture over 5 years of follow-up. Within each SPR category, risk of fracture increased as the FRAX categorisation of risk increased. In GLOW, only 11% of women with a lower baseline SPR were taking AOM at baseline, compared with 46% of women with a higher SPR. AOM use tended to increase in the years after a reported fracture. However, women with a lower SPR who were fractured still reported lower AOM rates than women with or without a fracture but had a higher SPR. CONCLUSIONS: These results suggest that SPR captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is also associated with improved medication uptake.
In this study, we report that self-perception of fracture risk captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is associated with improved medication uptake. It suggests that adequate appreciation of fracture risk may be beneficial and lead to greater healthcare engagement and treatment. INTRODUCTION: This study aimed to assess how well self-perception of fracture risk, and fracture risk as estimated by the fracture prediction tool FRAX, related to fracture incidence and uptake and persistence of anti-osteoporosis medication among women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). METHODS: GLOW is an international cohort study involving 723 physician practices across 10 countries in Europe, North America and Australia. Aged ≥ 55 years, 60,393 women completed baseline questionnaires detailing medical history, including co-morbidities, fractures and self-perceived fracture risk (SPR). Annual follow-up included self-reported incident fractures and anti-osteoporosis medication (AOM) use. We calculated FRAX risk without bone mineral density measurement. RESULTS: Of the 39,241 women with at least 1 year of follow-up data, 2132 (5.4%) sustained an incident major osteoporotic fracture over 5 years of follow-up. Within each SPR category, risk of fracture increased as the FRAX categorisation of risk increased. In GLOW, only 11% of women with a lower baseline SPR were taking AOM at baseline, compared with 46% of women with a higher SPR. AOM use tended to increase in the years after a reported fracture. However, women with a lower SPR who were fractured still reported lower AOM rates than women with or without a fracture but had a higher SPR. CONCLUSIONS: These results suggest that SPR captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is also associated with improved medication uptake.
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