In an article recently published by JAMA Internal Medicine, lead author Kristine Ensrud, MD, Professor of Medicine at the University of Minnesota Medical School, examines the impact of disease definition, comorbidity burden and prognosis of hip fracture probability among women 80 years and older.
Late-life women account for the majority of hip fractures in the United States, but are not screened for osteoporosis. Old age, multi-morbidity and poor health are risk factors for hip fracture, but these characteristics also increase the risk of competing, non-fracture related mortality. Thus, clinicians have difficulty identifying late-life women most likely to benefit from drug treatment to prevent hip fractures.
This recent study found late-life women with osteoporosis, including those with comorbidity of poorer prognosis, had a high probability of hip fracture in the next 5 years, even after accounting for competing mortality risk. These results suggest this group of women may derive a high absolute benefit from initiation of drug treatment candidates by the National Osteoporosis Foundation. In this study, mortality probability far outweighed the probability of hip fracture, especially among those with more comorbidities or poorer prognosis. These findings suggest that the absolute benefit of drug treatment to prevent fracture is much lower in this latter patient population.
Ensrud hopes this kind of study might inform treatment guidelines, making them less likely to focus on a single disease in isolation and become more patient-focused.