Effect of co-morbidities on fracture risk: Findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW) Journal Articles uri icon

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  • INTRODUCTION: Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. MATERIALS AND METHODS: We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. RESULTS: Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson's disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6-3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. CONCLUSION: Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson's disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.


  • Dennison, Elaine M
  • Compston, Juliet E
  • Flahive, Julie
  • Siris, Ethel S
  • Gehlbach, Stephen H
  • Adachi, Jonathan Derrick
  • Boonen, Steven
  • Chapurlat, Roland
  • Díez-Pérez, Adolfo
  • Anderson, Frederick A
  • Hooven, Frederick H
  • LaCroix, Andrea Z
  • Lindsay, Robert
  • Netelenbos, J Coen
  • Pfeilschifter, Johannes
  • Rossini, Maurizio
  • Roux, Christian
  • Saag, Kenneth G
  • Sambrook, Philip
  • Silverman, Stuart
  • Watts, Nelson B
  • Greenspan, Susan L
  • Premaor, Melissa
  • Cooper, Cyrus

publication date

  • June 2012

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