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Dysmobility Syndrome Independently Increases Fracture Risk in the Osteoporotic Fractures in Men (MrOS) Prospective Cohort Study

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Buehring B1, Hansen KE1, Lewis BL1, Cummings SR2, Lane NE3, Binkley N1, Ensrud KE4, Cawthon PM2; Osteoporotic Fractures in Men (MrOS) Study Research Group. J Bone Miner Res. 2018 Apr 27. doi: 10.1002/jbmr.3455. [Epub ahead of print]

Abstract

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1 University of Wisconsin, Madison, WI.

2 San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA.

3 University of California, Davis, CA.

4 University of Minnesota, Minneapolis, MN.

Abstract

We proposed the term "dysmobility syndrome" (DS) to identify individuals with impaired musculoskeletal health, a risk factor for falls and fractures. Whether DS is associated with increased risk of incident fracture is unknown. The "Osteoporotic Fractures in Men" study enrolled 5994 men ages ≥65 years, between March 2000 and April 2002. We used baseline data to determine whether DS increased fracture risk, independent of FRAX. Men met DS criteria at baseline if they had ≥3 of the following: appendicular lean mass/height2 <7.26 kg/m2 , total body fat >30%, spine or hip T-score ≤-2.5, grip strength <30 kg, gait speed <1.0 m/s, and ≥1 fall within 12 months. We examined whether baseline DS increased the risk of hip and major osteoporotic fractures (MOF) over a median of 14 (IQR 9, 15) years. Among 5834 men mean age 74 ± 6 years, 471 (8%) had DS and 635 (11%) experienced a MOF, including 274 (5%) hip fractures. Age (per SD increase) conferred a HR of 1.72 (95% CI, 1.59, 1.86), DS conferred a HR of 3.45 (95% CI 2.78, 4.29,) and FRAX calculated with BMD (per %) conferred a HR of 1.10 (95% CI 1.08, 1.11) for MOF. Prediction of MOF using the FRAX score provided a concordance value of 0.67 (SE 0.012). Concordance increased to 0.69 (SE 0.012) by adding DS and to 0.70 (SE 0.012 by adding DS and age to the multivariate model. Kaplan Meier curves indicated that men with both DS and a FRAX risk above the National Osteoporosis Foundation treatment thresholds had higher MOF (HR 6.23, 95% CI 3.10, 12.54) and hip (HR 7.73, 95% CI 5.95, 10.04) fracture risk than men with neither condition. We suggest further studies to determine the optimal criteria for DS, and to test DS as a predictor of falls and fractures, especially in women.