Abstract
This cross-sectional, observational study was designed to identify clinical risk factors of osteoporosis and fractures in Korean women to validate the probability of osteoporosis and subsequent fractures. A total of 1541 Korean women were recruited nationally. Fracture history of any site, risk factors of osteoporosis, and fall-related risk factors were surveyed and physical performance tests were conducted. Peripheral dual-energy X-ray absorptiometry was used to measure calcaneus bone mineral density (BMD). The number of positive responses on the modified 1-min osteoporosis risk test was related to the risk of osteoporosis. The frequency of osteoporosis was higher in those with a height reduction of >4 cm and a reduced body mass index (BMI). Multivariate analysis showed that older age and lower BMI were related to higher relative risk of osteoporosis. Time required to stand up from a chair and questions related to fall injury were significantly related to clinical fracture history of any site. Multivariate analysis showed that the relative risk of fractures at any site was higher in older subjects with a lower T-score and parental hip fracture history. This study shows that age and BMI are the most significant clinical risk factors for osteoporosis and that age, BMD, and parental history of hip fracture are highly applicable risk factors for validating the probability of osteoporotic fractures in Korean women.
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References
World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Technical Report Series 843. WHO, Geneva
Consensus development conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650
Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T (2007) Bone mineral density is not sensitive enough to assess the risk of vertebral fractures in type 2 diabetic women. Calcif Tissue Int 80:353–358
Cummings SR, Nevitt MC, Bowner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773
Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589
Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAXTM and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397
Fujiwara S, Nakamura T, Orimo H, Hosoi T, Gorai I, Oden A, Johansson H, Kanis JA (2008) Development and application of a Japanese model of the WHO fracture risk assessment tool (FRAXTM). Osteoporos Int 19:429–435
Sambrook PN, Cameron ID, Chen JS, Cumming RG, Lord SR, March LM, Schwarz J, Seibel MJ, Simpson JM (2007) Influence of fall-related factors and bone strength on fracture risk in the frail elderly. Osteoporos Int 18:603–610
Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707
O’Loughlin JL, Robitaille Y, Boivin JF, Suissa S (1993) Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 137:342–354
Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337:1279–1284
Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, Nebiker M, Theiler R, Pfeifer M, Begerow B, Lew RA, Conzelmann M (2003) Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 18:343–351
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413
Kung A (2004) Epidemiology and diagnostic approaches to vertebral fractures in Asia. J Bone Miner Metab 22:170–175
Liu J, Ning G, Chen J (2007) Osteoporotic fractures in Asia: risk factors and strategies for prevention. Osteoporos Int 25:1–5
Lim S, Koo BK, Lee EJ, Park JH, Kim MH, Shin KH, Ha YC, Cho NH, Shin CS (2008) Incidence of hip fractures in Korea. J Bone Miner Metab 26:400–405
Lau EMC, Suriwongpaisal P, Lee JK, Das De S, Festin MR, Saw SM, Khir A, Torralba T, Sham A, Sambrook P (2001) Risk factors for hip fracture in Asian men and women: the Asian Osteoporosis Study. J Bone Miner Res 16:572–580
Black DM, Steinbuch M, Palermo L, Dargent-Molina P, Lindsay R, Hoseyni MS, Johnell O (2001) An assessment tool for predicting fracture risk in postmenopausal women. Osteoporos Int 12:519–528
Miller PD, Siris ES, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Chen Y, Berger ML, Santora AC, Sherwood LM (2002) Prediction of fracture risk in postmenopausal white women with peripheral bone densitometry: evidence from the National Osteoporosis Risk Assessment. J Bone Miner Res 17:2222–2230
Albrand G, Munoz F, Sornay-Rendu E, DuBoeuf F, Delmas PD (2003) Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: the OFELY study. Bone 32:78–85
Reginster J, Ben Sedrine M, Viethel P, Micheletti M, Chevallier T, Audran M (2004) Validation of OSIRIS®, a prescreening tool for the identification of women with an increased risk of osteoporosis. Gynecol Endocrinol 18:3–8
Richy F, Deceulaer F, Ethgen O, Bruyere O, Reginster J (2004) Development and validation of the ORACLE score to predict risk of osteoporosis. Mayo Clin Proc 79:1402–1408
Papaioannou A, Joseph L, Ioannidis G, Berger C, Anastassiades T, Brown JP, Hanley DA, Hopman W, Josse RG, Kirkland S, Murray TM, Olszynski WP, Pickard L, Prior JC, Siminoski K, Adachi JD (2005) Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 16:568–578
Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B, Oden A, Zethraeus N, Pfleger B, Khaltaev N (2005) Assessment of fracture risk. Osteoporos Int 16:581–589
Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Scott AM, Hausherr E, Meunier PJ, Breat G (1996) Fall-related factors and risk of hip fracture: the EPIDOS prospective study. Lancet 348:145–149
Geusens P, Milisen K, Dejaeger E, Boonen S (2003) Falls and fractures in postmenopausal women: a review. J Br Menopause Soc 9:101–106
WHO/IASO/IOTF (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Health Communications, Australia
Koh LKH, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, Huang QR, Rajatanavin R, Tsai KS, Park HM (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699–705
Park HM, Sedrine WB, Reginster JY, Ross PD (2003) Korean experience with the OSTA risk index for osteoporosis: a validation study. J Clin Densitom 6:247–250
Shin A, Choi J, Cung H, Park SK, Shin CS, Choi Y, Cho S, Kim D, Kim D, Lee K, Lee KH, Yoo K, Kang D (2004) Prevalence and risk factors of distal radius and calcaneus bone mineral density in Korean population. Osteoporos Int 15:639–644
Deng HW, Mahaney MC, Williams JT, Li J, Conway T, Davies KM, Li JL, Deng H, Recker RR (2002) Relevance of the genes for bone mass variation to susceptibility to osteoporotic fractures and its implications to gene search for complex human diseases. Genet Epidemiol 22:12–25
Andrew T, Antioniades L, Scurrah KJ, Macgregor AJ, Spector TD (2005) Risk of wrist fracture in women is heritable and is influenced by genes that are largely independent of those influencing BMD. J Bone Miner Res 20:67–74
Pinheiro MM, Castro CHM, Frisoli A Jr, Szejnfeld VL (2003) Discriminatory ability of quantitative ultrasound measurements is similar to dual-energy X-ray absoroptiometry in a Brazilian women population with osteoporotic fracture. Calcif Tissue Int 73:555–564
Patel R, Blake GM, Fogelman I (2007) Peripheral and central measurements of bone mineral density are equally strongly associated with clinical risk factors for osteoporosis. Calcif Tissue Int 80:89–96
Patel S, Hyer S, Tweed K, Kerry S, Allan K, Rodin A, Barron J (2008) Risk factors for fractures and falls in older women with type 2 diabetes mellitus. Calcif Tissue Int 82:87–91
Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner W, Nevitt M, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18:1947–1954
Sweeney AT, Malabanan AO, Blake MA, Weinberg J, Yurner A, Ray P, Holick MF (2002) Bone mineral density assessment: comparison of dual-energy X-ray absorptiometry measurements at the calcaneus, spine, and hip. J Clin Densitom 5:57–62
Acknowledgments
The authors thank the co-investigators and those who participated voluntarily in the free osteoporosis examination campaign. The co-investigators were: Hye Jung Kim, M.D., Wonkwang University Hospital; Yeun Sun Kim, M.D., Gachon University Gil Medical Center; Soon Hee Lee, M.D., Inje University Pusan Paik Hospital; Ji Hyun Park, M.D., Chonbuk National University Hospital; Yumie Rhee, M.D., Yonsei University College of Medicine; and Young Jun Won, M.D., Kwandong University Myongji Hospital. This study was supported by sanofi-aventis Korea Co., Ltd. All authors had access to all of the data used in this analysis.
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Kim, Y.M., Hyun, NR., Shon, HS. et al. Assessment of Clinical Risk Factors to Validate the Probability of Osteoporosis and Subsequent Fractures in Korean Women. Calcif Tissue Int 83, 380–387 (2008). https://doi.org/10.1007/s00223-008-9182-x
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DOI: https://doi.org/10.1007/s00223-008-9182-x