Is Inflammatory Bowel Disease a Risk Factor for Fracture? An Analysis Using the Fracture Risk Assessment Tool (FRAX): 2011 ACG Presidential Poster
Bibliographic record
Abstract
Purpose: Persons with inflammatory bowel disease (IBD) have been reported to be at increased risk both of osteoporosis and major osteoporosis fractures (MOF), comprising fractures of the hip, vertebra, distal radius, or humerus. The WHO FRAX score is a risk assessment tool which utilizes age, sex, BMI, clinical risk factors, and femoral neck bone mineral density (BMD) to estimate the 10-year probability of hip fracture (HF) and MOF. It is unclear whether IBD predicts MOF or HF independent of FRAX, whether the increased fracture risk seen in IBD patients is accounted for in the component variables of the FRAX score, or whether the IBD subtype - Crohn's Disease (CD) vs. ulcerative colitis (UC) - have differential effects on the risk of fracture. Methods: We performed an analysis of linked data from the Manitoba Bone Mineral Density Database and the University of Manitoba IBD Epidemiologic Database (UMIBDED). The MBMDD contains information on all Manitobans having undergone clinical testing with dual x-ray absorptiometry (DXA) along with information on other risk factors for fracture, anthropometric measures, FRAX probability scores and medication use. The UMIBDED is a population based database containing healthcare utilization on all Manitobans with IBD. Analysis was restricted to persons over the age of 50. MOF and HF outcomes were ascertained from comprehensive population-based administrative healthcare databases using validated definitions. Multivariate Cox proportional hazards modelling was used to determine whether having a diagnosis of IBD was independently associated with an increased risk of MOF and HF (after controlling for the composite FRAX score). Results: 39,502 persons over age 50 underwent at least one DXA, of whom 752 had IBD. The FRAX score was strongly predictive of MOF and HF in IBD and non-IBD subgroups (all p<.001). IBD was not associated with an increased risk of MOF after controlling for the FRAX score (HR 1.15, 95% CI 0.85-1.50). However, IBD was associated with an increased risk of HF after controlling for the FRAX score (HR 1.94, 95% CI 1.21-3.10). Risk of MOF and HF were similar among subjects with CD and UC. (CD vs. UC; HR 1.07, 95% CI 0.63-1.81; for MOF, HR 0.85, 95% CI 0.33-2.17 for HF). Conclusion: Though IBD does not appear to be predictive of fracture after controlling for FRAX, IBD does predict hip fracture independent of FRAX. This suggests that having IBD may be predictive of hip fracture independent of the effects of IBD on other known risk factors for hip fracture including BMD. Further work is required to see which patients with IBD are at highest risk of hip fracture in order to guide the use of preventive therapies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".