MedicalResearch.com Interview with:
Kristine E. Ensrud MD MPH
Professor of Medicine and Epidemiology and Community Health
University of Minnesota
Core Investigator, Center for Care Delivery and Outcomes Research
Minneapolis VA Health Care System
MedicalResearch.com: What is the background for this study?
Response: Women aged 80 years and older, a rapidly growing segment of the population, account for the majority of hip fractures in the United States. Hip fractures account for 72% of fracture-related health care expenditures and lead to significant morbidity and mortality. However, many late-life women at high risk of hip fracture are undiagnosed. Clinicians have difficulty identifying late-life women most likely to benefit from osteoporosis screening and interventions to prevent hip fracture in part due to concerns about comorbidity burden and prognosis in this patient population.
MedicalResearch.com: What are the main findings?
Response: Women 80 years and older with osteoporosis, including those with more comorbid medical conditions or poorer prognosis, have a high 5-year hip fracture probability despite accounting for their competing risk of non-fracture mortality. In contrast, among women 80 years and older without osteoporosis but considered to be treatment candidates on the basis of osteopenia and a fracture probability at or above intervention thresholds proposed by the National Osteoporosis Foundation, competing mortality risk far outweighs hip fracture probability, especially among those with more comorbidities or poorer prognosis.
MedicalResearch.com: What should readers take away from your report?
Response: Women 80 years and older including those with multimorbidity or estimated shorter life expectancy should be counseled about their risk of hip fracture and be considered for osteoporosis screening with bone mineral density testing. Clinicians should consider the initiation of drug treatment to prevent fracture in late-life women with osteoporosis (bone mineral density (BMD) T-score -2.5 or below) and multiple comorbidities, as this group of women may derive the greatest absolute benefit of treatment in preventing future hip fractures.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Research is needed to to develop fracture prediction models in adults 80 years and older that account for individual patient competing risk of death and incorporate late-life risk factors such as multimorbidity in addition to BMD. In addition, well-designed observational studies are essential to evaluate the efficacy and safety of osteoporosis medications in this patient population.
Ensrud KE, Kats AM, Boyd CM, et al. Association of Disease Definition, Comorbidity Burden, and Prognosis With Hip Fracture Probability Among Late-Life Women. JAMA Intern Med. Published online June 17, 2019. doi:10.1001/jamainternmed.2019.0682
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