Background Osteoporosis, obesity and sarcopenia are risk factors for fractures and their combination has a negative effect on musculoskeletal health (MSKH). We proposed a score-based approach to define this combination as “dysmobility syndrome (DS)”. DS increases mortality in the NHANES cohort but no data exist on fracture risk. The most widely used fracture risk calculator, the WHO FRAX® tool, does not include several measures of MSKH such as physical function, muscle mass or falls. In this analysis of the Osteoporotic Fractures in Men (MrOS) cohort, we examine whether individuals with impaired MSKH/DS have a higher incidence of fragility fractures and whether this composite score confers additional risk for fracture, beyond risk estimates provided by FRAX®.
Objectives In this analysis of the Osteoporotic Fractures in Men (MrOS) cohort, we examine whether individuals with impaired MSKH/DS have a higher incidence of fragility fractures and whether this composite score confers additional risk for fracture, beyond risk estimates provided by FRAX®.
Methods The MrOS cohort was utilized in this study. The score-based approach to define DS includes six factors with one point assigned to each: appendicular lean mass/height2 <7.26 kg/m2, body fat >30%, T-score ≤-2.5, grip strength <30 kg, gait speed <1.0 m/s, and falls in last 12 months. A score ≥3 indicated DS. We use odds ratios and cox proportional hazard models to analyze risks of major osteoporotic fracture (MOF). Men were censored at the time of fracture or last follow up. We determined the hazards of fracture using presence of dysmobility syndrome, the FRAX® score, and the FRAX® score in quartiles. We used the program R (www.rproject.org) to perform all analyses.
Results 5827 men ages 74±6 years with a mean BMI of 27.4±3.8 kg/m2 had complete data necessary for this analysis. 391 males (6.7%) met criteria for DS. 571 (10%) experienced a MOF including 245 (4%) hip fractures. DS increased the hazards of major osteoporotic (HR 3.31, 95% CI, 2.58, 4.23) and hip (HR 3.48, 95% CI 2.41, 5.03) fractures. In adjusted models, DS and elevated FRAX® risk each increased the hazards of major osteoporotic and hip fracture. Interaction models showed no significant interaction between the presence of DS and FRAX® score for major osteoporotic (p=0.184) or hip (p=0.177) fractures.
Conclusions DS was associated with increased MOF fracture incidence even after adjusting for quartiles of FRAX® risk in this cohort of older men. Our study suggests that using a composite assessment of MSKH in addition to already available tools such as FRAX® may improve identification of individuals at high fracture risk. Additional analyses are necessary to examine whether this approach can better distinguish between those who will fracture and who will not and whether the results can be reproduced in women.
Disclosure of Interest None declared
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