Fracture Risk Prediction After Age 80 Years

大多数临床骨折包括髋部骨折发生在80岁及以上的成年人中，但也有 缺乏证据来指导评估骨折风险与竞争死亡风险之间的关系 病人群体。临床医生很难识别出老年患者是骨折风险最高的患者，因为 预期生存对这种风险有很大影响。目前没有足够可用的骨折风险评估工具 解决与高龄老年人骨折预测相关的重要问题，包括选择适当的 骨折预测的时间框架，包括老年骨折和死亡率的关键风险因素，以及 考虑患者在给定一组风险因素的情况下的竞争死亡风险。我们的初步数据 建议将诸如脆弱表型等非骨骼危险因素添加到骨折预测模型中 将改善其在晚年成年人中的表现。因此，迫切需要实用的骨折风险 评估模型，更好地识别9岁和10岁年龄段的女性和男性患高血压的风险 骨折。我们的研究将结合在三个大型流行病学队列中收集的全面数据(研究 骨质疏松性骨折[SOF]；男性骨质疏松性骨折研究[MROS]；健康老龄化与身体 成分研究[Health ABC])在社区居住的女性和男性中产生骨折预测模型 80岁及以上，清楚地定义了个人和综合风险因素之间的关系 骨折是竞争死亡风险的原因，并表现出优于现有的 工具。我们将考虑到相关的晚年非骨骼因素，生成5年和终身风险的估计 骨折和死亡率的预测因素包括多发病、功能受限、多药联用、虚弱 表型及其成分，如萎缩、虚弱和迟缓。此外，我们还将评估 骨密度在骨折预测中的作用，包括其与晚年非骨骼危险因素的相互作用。有效寿命 在充分考虑患者相互竞争的死亡风险的情况下进行风险评估，以确定 那些死前骨折风险最高的人。此外，在这些高风险中，5年预测时间框架 考虑到预期的死亡风险，临床决策需要考虑竞争死亡风险的患者 降低骨折风险和减少预期寿命的干预措施的受益时间范围。成功 我们目标的实现将通过明确识别高危患者来改善临床决策 骨折风险高，应作为骨折筛查和预防措施的目标群体 尽管考虑了相互竞争的死亡风险和风险较低的亚组，但这些策略可能 益处微乎其微，因为竞争死亡的风险远远超过骨折的风险。这些结果对指导 在美国这一快速增长的细分市场中进行骨折风险评估和共享临床决策 骨折事件和竞争性非骨折的共同危险因素负担较高的人群 相关死亡率。

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.