Chronic myeloproliferative neoplasms and risk of osteoporotic fractures; a nationwide population-based cohort study

Abstract Abstract 2835 Background: The classical chronic myeloproliferative neoplasms (CMPNs), including essential thrombocytemia (ET), polycythemia vera (PV), and chronic myeloid leukemia (CML), are disorders characterized by accelerated proliferation of hematopoietic tissue. Systemic mastocytosis, also a chronic myeloproliferative neoplasm, has been associated with increased risk of osteoporosis. However, to our knowledge, no data is available on the risk of osteoporosis among patients with classical CMPNs. Method: We conducted a Danish population-based cohort study of the risk of osteoporosis among patients with ET, PV, and CML using data from the Danish health care system. ET, PV, and CML patients were identified from Danish National Registry of Patients (DNRP), and linked to the Danish Civil Registration System (CRS) in the study period 1 January 1980 to 31 December 2010. Each Danish resident has a unique, permanent 10-digit civil registry number allowing unambiguous individual-level linkage among all Danish registries. Patients with a first-ever CMPN diagnosis in the DNRP were identified by means of their ICD-8 diagnosis code until 1994 and ICD-10 diagnosis code thereafter. By this means, we established three distinct cohorts of ET, PV, and CML patients. For each CMPN patient, 50 general population comparison cohort members without CMPN were identified in the CRS matched on age, sex, and calendar year, creating three comparison cohorts. Follow-up started 1-year from the date of diagnosis for CMPN patients. The comparison cohort members were assigned the same index date as their index CMPN case. A diagnosis of proximal femoral fracture was used an indicator of osteoporosis, since this fracture type invariably leads to hospitalization, and therefore would be registered in the DNRP throughout our observation period. The CMPN and comparison cohorts were followed until a diagnosis of femoral fracture, emigration, death, or 31 December 2010, whichever came first. Patients and comparison cohort members with a previous diagnosis of osteoporosis or osteoporotic fractures were excluded. The Kaplan-Meier method was used to estimate the cumulative rate of fractures. Cox regression was used to estimate hazard ratios (HRs) as a measure of relative risk of femoral fracture for each CMPN cohort compared to the comparison cohort, adjusted for comorbidity. Results: We identified 7,595 MPN patients (1,864 with ET; 4,418 with PV; and 1,313 with CML) and 338,974 comparison cohort members. The cumulative rate of proximal femoral fractures was higher among CMPN patients than among comparison cohort members, as depicted in the Figures. The rate of fractures per 1,000 person-years were: 6.6 (95% confidence interval (CI): 5.2–8.3) for ET patients [comparison group: 5.3 (95% CI: 5.1–5.4)], 9.9 (95% CI: 8.8–11.0) for PV patients [comparison group: 6.2 (95% CI: 6.1–6.3)]; and 8.2 (95% CI: 6.0–10.7) for CML patients [comparison group: 4.4 (95% CI: 4.3–4.6)]. The resulting adjusted hazard ratios (HR) were: HRET = 1.2 (95% CI: 0.9–1.5), HRPV = 1.8) (95% CI: 1.6–2.0), and HRCML = 2.7 (95% CI: 2.0–3.6). Conclusion: CMPN patients are at higher risk of osteoporotic fractures than the general population. Disclosures: No relevant conflicts of interest to declare.

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Fragility Fractures and Imminent Fracture Risk in the Spanish Population: A Retrospective Observational Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10051082 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1082

Author(s):

Maria-José Montoya-García ◽

Mercè Giner ◽

Rodrigo Marcos ◽

David García-Romero ◽

Francisco-Jesús Olmo-Montes ◽

...

Keyword(s):

Cohort Study ◽

Incidence Rate ◽

Public Health Problem ◽

Osteoporotic Fractures ◽

Fragility Fractures ◽

Population Based ◽

High Morbidity ◽

Major Public Health Problem ◽

Skeletal Site ◽

Mortality Incidence

Fragility fractures constitute a major public health problem worldwide, causing important high morbidity and mortality rates. The aim was to present the epidemiology of fragility fractures and to assess the imminent risk of a subsequent fracture and mortality. This is a retrospective population-based cohort study (n = 1369) with a fragility fracture. We estimated the incidence rate of index fragility fractures and obtained information on the subsequent fractures and death during a follow-up of up to three years. We assessed the effect of age, sex, and skeletal site of index fracture as independent risk factors of further fractures and mortality. Incidence rate of index fragility fractures was 86.9/10,000 person-years, with highest rates for hip fractures in women aged ≥80 years. The risk of fracture was higher in subjects with a recent fracture (Relative Risk(RR), 1.80; p < 0.01). Higher age was an independent risk factor for further fracture events. Significant excess mortality was found in subjects aged ≥80 years and with a previous hip fracture (hazard ratio, 3.43 and 2.48, respectively). It is the first study in Spain to evaluate the incidence of major osteoporotic fractures, not only of the hip, and the rate of imminent fracture. Our results provide further evidence highlighting the need for early treatment.

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Heart Failure Is a Clinically and Densitometrically Independent Risk Factor for Osteoporotic Fractures: Population-Based Cohort Study of 45,509 Subjects

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2011-3055 ◽

2012 ◽

Vol 97 (4) ◽

pp. 1179-1186 ◽

Cited By ~ 34

Author(s):

Sumit R. Majumdar ◽

Justin A. Ezekowitz ◽

Lisa M. Lix ◽

William D. Leslie

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cohort Study ◽

Osteoporotic Fractures ◽

Population Based ◽

Recent Onset ◽

Major Osteoporotic Fractures ◽

Hip Bmd ◽

Osteoporosis Risk Factors ◽

Osteoporosis Risk

Objective: The aim of the study was to determine whether heart failure is associated with an increased risk of major osteoporotic fractures that is independent of bone mineral density (BMD). Methods: We conducted a population-based cohort study in Manitoba, Canada, by linking a clinical registry of all adults 50 yr of age and older who underwent initial BMD testing from 1998–2009 with administrative databases. We collected osteoporosis risk factors, comorbidities, medications, and BMD results. Validated algorithms identified recent-onset heart failure before the BMD test and new fractures after. The main outcome was time to major osteoporotic fractures (i.e. clinical vertebrae, distal forearm, humerus, and hip), and multivariable proportional hazards models were used for analyses. Results: The cohort consisted of 45,509 adults; 1,841 (4%) had recent-onset heart failure. Subjects with heart failure were significantly (P < 0.001) older (74 vs. 66 yr) and had more previous fractures (21 vs. 13%) and lower total hip BMD [T-score, −1.3 (sd 1.3) vs. −0.9 (sd 1.2)] than those without. There were 2703 incident fractures over the 5-yr observation. Overall, 10% of heart failure subjects had incident major fractures compared with 5% of those without [unadjusted hazard ratio (HR), 2.45; 95% confidence interval (CI), 2.11–2.85]. Adjustment for osteoporosis risk factors, comorbidities, and medications attenuated but did not eliminate this association (HR, 1.33; 95% CI, 1.11–1.60), nor did further adjustment for total hip BMD (HR, 1.28; 95% CI, 1.06–1.53). Conclusions: Heart failure is associated with a 30% increase in major fractures that is independent of traditional risk factors and BMD, and it also identifies a high-risk population that may benefit from increased screening and treatment for osteoporosis.

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