MODELING FRACTURE RISK USING BONE-DENSITY, AGE, AND YEARS SINCE MENOPAUSE

Introduction: Preventive strategies are essential for reducing the inc idence of osteoporosis and its consequences. However, simple algorithm s that predict an individual's future risk of fractures are scarce. Th e purpose of the study was to define a clinical decision aid that enab les physicians to project an individual's lifetime fracture risk and t herefore institute preventive therapies.Methods: A predictor equation for bone loss was developed using bone mineral density (BMD), age, yea rs since menopause, and weight. This was applied to normal and osteopo rotic women, ages 40-80 years (n = 117) screened for osteoporosis stud ies. Results: A spinal BMD cutoff of 0.86 gm/cm(2) had a sensitivity o f 90% and a specificity of 60% for detecting subjects with vertebral f ractures and was therefore defined as a high-risk BMD.Using the parame ter estimates from the above equation and an individual's clinical dat a, we derived prediction curves-to forecast the age at which that indi vidual would reach the above defined high-risk BMD, and therefore that person's expected number of remaining life-years at high risk for fra ctures. Conclusions: This study proposes a conceptual framework for th e development of a clinical decision aid to provide guidelines for the prevention of osteoporosis. A longitudinal study that incorporates ot her variables such as prevalent fractures and biochemical markers of b one turnover would further validate this model and enhance its applica tion.