Development of a simple prognostic nomogram for individualising 5-year and 10-year absolute risks of fracture: a population-based prospective study among postmenopausal women
- Tineke A C M van Geel1,
- Nguyen D Nguyen2,
- Piet P Geusens3,
- Jacqueline R Center2,
- Tuan V Nguyen2,
- Geert-Jan Dinant1,
- John A Eisman2
- 1Department of General Practice, Maastricht University/Caphri School for Public Health and Primary Care, Maastricht, The Netherlands
- 2Garvan Institute of Medical Research, Osteoporosis and Bone Biology Program, Sydney, Australia
- 3Department of Internal Medicine, Maastricht University Medical Centre/Caphri School for Public Health and Primary Care, Maastricht, The Netherlands
- Correspondence to Tineke A C M van Geel, Department of General Practice, Maastricht University/Caphri School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, The Netherlands;
- Accepted 10 July 2010
- Published Online First 27 September 2010
Objectives Previous fracture prediction models have been based on the assumption of a stable risk of subsequent fractures over time. The aim of the present work was to develop a nomogram for prediction of 5-year and 10-year individualised absolute fracture risks for postmenopausal women taking into account the time relation between fractures.
Methods A population-based prospective study was performed in 23 general practice centres located in the southern part of The Netherlands. At baseline (1992–1994), 4203 postmenopausal women between 50 and 80 years participated and 2372 of them also participated 10 years later. Baseline measurements included lumbar spine bone mineral density (BMD) and clinical risk factor evaluation. The incidence of fractures was ascertained. Bayesian model averaging and Cox's proportional hazards model were used.
Results After enrolment, 382 (16.1%) women had a clinical fracture. Fracture risk was associated with advancing age (HR 1.09 per SD (5 years); 95% CI 1.01 to 1.17), lumbar spine BMD (HR 1.23 per −1 SD; 95% CI 1.10 to 1.37) and a prior fracture, with HR 3.27 (95% CI 2.50 to 4.30) for a recent prior fracture (≤5 years previously) and HR 1.97 (95% CI 1.43 to 2.71) for a non-recent prior fracture after menopause (>5 years previously). Women with a recent prior fracture had 66% higher risk of an incident fracture than those with a non-recent prior fracture (HR 1.66; 95% CI 1.15 to 2.40).
Conclusions The nomogram developed can help doctors to inform patients more effectively and thus better manage patient care by providing an individualised fracture risk taking into account the time relationship for fractures.
Funding This project was supported by grants from Maastricht University. All researchers are independent from funders in regards to this study.
Competing interests JAE (consulting fees or other remuneration): Amgen, Decode, Eli Lilly, Ge-Lunar, Merck Sharp & Dohme, Novartis, Roche-GSK, Sanofi-Aventis, Servier and Wyeth Australia. PPG (consulting fees or other remuneration): Amgen, Eli Lilly, Ge-Lunar, Merck Sharp & Dohme, Novartis, Roche-GSK, Sanofi-Aventis, Servier, Wyeth, Schering Plough, Abbott, Pfizer. Other authors: none.
Ethics approval This study was conducted with the approval of the Ethical Review Committee of Maastricht University and the Maastricht University Hospital (reference number MEC 94-196.1). Written informed consent forms were obtained from all participants.
Provenance and peer review Not commissioned; externally peer reviewed.