ISSN 2052-1219 (online)

Bone Abstracts (2013) 1 OC1.1 | DOI: 10.1530/boneabs.01.OC1.1

Disease-specific perception of fracture risk and incident fracture rates among postmenopausal women: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW)

Celia Gregson1,2, Elaine Dennison2, Juliet Compston3, Silvano Adami4, Jonathan Adachi5, Frederick Anderson6, Steven Boonen7, Roland Chapurlat8, Adolfo Díez-Pérez9, Susan Greenspan10, Frederick Hooven6, Andrea Lacroix11, Jeri Nieves12, J Coen Netelenbos13, Johannes Pfeilschifter14, Maurizio Rossini4, Christian Roux15, Kenneth Saag16, Stuart Silverman17, Ethel Siris18, Nelson Watts19, Allison Wyman6 & Cyrus Cooper2,20

1Musculoskeletal Research Unit, University of Bristol, Bristol, UK; 2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; 3School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK; 4Department of Rheumatology, University of Verona, Ospedale, Verona, Valeggio, Italy; 5St Joseph’s Hospital, McMaster University, Hamilton, Ontario, Canada; 6UMASS Medical School, Centre for Outcomes Research, Worcester, Massachusetts, USA; 7Division of Geriatric Medicine, Leuven University Center for Metabolic Bone Diseases, Katholieke Universiteit Leuven, Leuven, Belgium; 8INSERM U831, Université de Lyon, Division of Rheumatology, Hôpital E Herriot, Lyon, France; 9Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain; 10University of Pittsburgh, Pittsburgh, Pennsylvania, USA; 11Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; 12Helen Hayes Hospital and Columbia University, West Haverstraw, New York, USA; 13Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands; 14Department of Internal Medicine III, Alfred Krupp Krankenhaus, Essen, Germany; 15Paris Descartes University, Cochin Hospital, Paris, France; 16University of Alabama-Birmingham, Birmingham, Alabama, USA; 17Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, California, USA; 18Department of Medicine, Columbia University Medical Center, New York, New York, USA; 19Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, Ohio, USA; 20Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Patients with improved health understanding have greater autonomy over, and motivation towards, health-related lifestyles. We compared self-perceived fracture risk and 3-year incident fracture rates in postmenopausal women for a range of co-morbid diseases using data from the Global Longitudinal study of Osteoporosis in Women (GLOW).

GLOW is an international cohort study involving 723 physician practices across 10 countries in Europe, North America, Australasia. 60 393 women aged ≥55 years completed baseline questionnaires detailing medical history, including co-morbidities, fractures and self-perceived fracture risk. Annual follow-up determined self-reported incident fractures.

In total, 2945/43 832 (6.7%) sustained an incident fracture over 3 years. All co-morbidities were strongly associated with increased fracture rates, particularly Parkinson’s disease (PD) (hazard ratio (HR) 95% CI; 3.89 (2.78, 5.44)), multiple sclerosis (MS) 2.70 (1.90, 3.83), cerebrovascular events 2.02 (1.67, 2.46), and rheumatoid arthritis 2.15 (1.53, 3.04), all P<0.001). Most individuals perceived their own fracture risk to be similar to (46%) or lower than (36%) women of the same age.

Increased self-perceived fracture risk was strongly associated with incident fracture rates. However, only 29% of women who experienced a fracture had perceived their risk as increased. Under-appreciation of fracture risk occurred for all co-morbidities, particularly for women with neurological disease, in whom women with self-perceived low fracture risk had a fracture HR of 2.39 (1.74, 3.29) compared with women without co-morbidities.

Our results suggest postmenopausal women with co-morbidities known to be associated with increased fracture rates tend to under-appreciate their risk, especially in the context of neurological diseases, where fracture rates are highest. Our findings have important implications for health education particularly among women with neurological disease and support updating of relevant guidelines.

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