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 Parkinsons 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.
18 - 21 May 2013
European Calcified Tissue Society