AbstractBackgroundIdentifying late-life men who might benefit from treatment to prevent fracture is challenging given high mortality. Our objective was to evaluate risks of clinical fracture, hip fracture, and mortality prior to fracture among men aged at least 80 years.MethodsStudy participants included 3 145 community-dwelling men (mean [standard deviation] age 83 [2.8] years) from the Osteoporotic Fractures in Men (MrOS) Study. We used separate multivariable Fine-Gray competing risk models with prespecified risk factors (age, hip bone mineral density [BMD], recent fracture [<5 years], fall history [previous year], and multimorbidity [# conditions]) to estimate subdistribution hazard ratios and absolute 5-year risks of any clinical fracture and mortality prior to clinical fracture. Secondary analysis considered a hip fracture.ResultsThere were 414 incident clinical fractures and 595 deaths without prior fracture within 5 years. BMD, fall history, and recent fracture were strong predictors of clinical fracture. Age and multimorbidity were strong predictors of mortality before fracture. After accounting for competing risks, age, BMD, and fall history were each associated with both risks of hip fracture and mortality before hip fracture. Model discrimination varied from 0.65 (mortality before fracture) to 0.79 (hip fracture). Estimated mortality differed substantially among men with similar clinical fracture risk due to a modest correlation between fracture risk and competing mortality risk = 0.37.ConclusionIn late-life men, strong risk factors for clinical fracture and hip fracture include fall history, BMD, and recent fracture. Osteoporosis drug treatment decisions may be further enhanced by consideration of fracture risk versus overall life expectancy.

中文翻译：

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晚年男性 5 年骨折风险与 5 年死亡风险的相关特征

摘要背景鉴于高死亡率，确定可能受益于预防骨折治疗的晚年男性具有挑战性。我们的目标是评估 80 岁以上男性的临床骨折、髋部骨折和骨折前死亡风险。方法研究参与者包括来自男性骨质疏松性骨折 (MrOS) 研究的 3 145 名社区男性（平均 [标准差] 年龄 83 [2.8] 岁）。我们使用单独的多变量 Fine-Gray 竞争风险模型和预先指定的风险因素（年龄、髋骨矿物质密度 [BMD]、近期骨折 [<5 年]、跌倒史 [前一年] 和多发病 [# 条件]）来估计任何临床骨折和临床骨折前死亡的亚分布风险比和绝对 5 年风险。二次分析认为是髋部骨折。结果5 年内，有 414 例临床骨折发生，595 例没有既往骨折死亡。BMD、跌倒史和近期骨折是临床骨折的有力预测因素。年龄和多种疾病是骨折前死亡率的有力预测因素。考虑到竞争风险后，年龄、骨密度和跌倒史均与髋部骨折的风险和髋部骨折前的死亡率相关。模型区分度从 0.65（骨折前死亡率）到 0.79（髋部骨折）不等。由于骨折风险和竞争死亡风险之间存在适度的相关性（0.37），因此具有相似临床骨折风险的男性之间的估计死亡率存在显着差异。结论对于晚年男性，临床骨折和髋部骨折的强烈危险因素包括跌倒史、BMD 和近期骨折。通过考虑骨折风险与总体预期寿命，骨质疏松症药物治疗决策可能会得到进一步改善。