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Measured height loss predicts incident clinical fractures independently from FRAX: a registry-based cohort study

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Abstract

Summary

During median follow-up 6.0 years in 11,495 individuals, prior absolute and annualized measured height loss was significantly greater in those with subsequent incident fracture compared with those without incident fracture.

Purpose

FRAX® accepts baseline height and weight as input variables, but does not consider change in these parameters over time.

Aim

To evaluate the association between measured height or weight loss on subsequent fracture risk adjusted for FRAX scores, risk factors, and competing mortality.

Methods

Using a dual-energy x-ray absorptiometry (DXA) registry for the Province of Manitoba, Canada, we identified women and men age 40 years or older with height and weight measured at the time of two DXA scans. Cox regression analyses were performed to test for a covariate-adjusted association between prior height and weight loss with incident fractures occurring after the second scan using linked population-based healthcare data.

Results

The study population consisted of 11,495 individuals (average age 68.0 ± 9.9 years, 94.6% women). During median follow-up 6.0 years, records demonstrated incident major osteoporotic fracture (MOF) in 869 individuals, hip fractures in 265, clinical vertebral fractures in 207, and any fracture in 1203. Prior height loss was significantly greater in individuals with fracture compared with those without fracture, regardless of fracture site. Mortality was greater in those with prior height loss (HR per SD 1.11, 95% CI 1.06–1.17) or weight loss (HR per SD 1.26, 95% CI 1.19–1.32). Each SD in height loss was associated with increased fracture risk (MOF 12–17%, hip 8–19%, clinical vertebral 28–37%, any fracture 14–19%). Prior weight loss was associated with 21–30% increased risk for hip fracture, but did not increase risk for other fractures. Height loss of 3.0 cm or greater more than doubled the risk for subsequent fracture.

Conclusions

Prior height loss is associated with a small but significant increase in risk of incident fracture at all skeletal sites independent of other clinical risk factors and competing mortality as considered by FRAX. Prior weight loss only increases risk for subsequent hip fracture.

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Acknowledgments

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). SNM is chercheur-boursier des Fonds de Recherche du Québec en Santé. LML is supported by a Tier I Canada Research Chair.

Author information

Authors and Affiliations

  1. Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada

    W.D. Leslie, P. Martineau & L.M. Lix

  2. Park Nicollet Clinic & HealthPartners Institute, Minneapolis, MN, USA

    J.T. Schousboe

  3. University of Minnesota, Minneapolis, MN, USA

    J.T. Schousboe

  4. McGill University, Montreal, Canada

    S.N. Morin

  5. Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, Beech Hill Rd, Sheffield, S10 2RX, UK

    H. Johansson, E.V. McCloskey & J.A. Kanis

  6. Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

    H. Johansson & J.A. Kanis

  7. Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK

    E.V. McCloskey

  8. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    N.C. Harvey

  9. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

    N.C. Harvey

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  1. W.D. Leslie
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Corresponding author

Correspondence to W.D. Leslie.

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Conflicts of interest

Suzanne Morin: Nothing to declare for the context of this paper, but has received research grants: Amgen.

Eugene McCloskey: Nothing to declare for the context of this paper, but numerous ad hoc consultancies/speaking honoraria and/or research funding from Amgen, Bayer, General Electric, GSK, Hologic, Lilly, Merck Research Labs, Novartis, Novo Nordisk, Nycomed, Ono, Pfizer, ProStrakan, Roche, Sanofi-Aventis, Servier, Tethys, UBS, and Warner-Chilcott.

Nicholas Harvey: Nothing to declare for the context of this paper, but has received consultancy/lecture fees/honoraria/grant funding from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, Consilient Healthcare, Radius Health, UCB, Kyowa Kirin, and Internis Pharma.

John A. Kanis: Grants from Amgen, Lilly, Radius Health and non-financial support from Medimaps outside the submitted work.

William Leslie, Patrick Martineau, Lisa Lix, Helena Johansson: No conflicts of interest.

Disclaimer

The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

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Leslie, W., Schousboe, J., Morin, S. et al. Measured height loss predicts incident clinical fractures independently from FRAX: a registry-based cohort study. Osteoporos Int 31, 1079–1087 (2020). https://doi.org/10.1007/s00198-020-05313-3

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  • DOI: https://doi.org/10.1007/s00198-020-05313-3

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