{"doi":"10.1002/jbmr.4103","title":"Lung-Specific Risk Factors Associated With Incident Hip Fracture in Current and Former Smokers","abstract":"ABSTRACT Hip fractures are associated with significant morbidity and mortality in smokers with lung disease, but whether lung-specific factors are associated with fracture risk is unknown. Our goal was to determine whether lung-specific factors associate with incident hip fracture and improve risk discrimination of traditional fracture risk models in smokers. The analysis consisted of a convenience sample of 9187 current and former smokers (58,477 participant follow-up years) participating in the Genetic Epidemiology of chronic obstructive pulmonary disease (COPD) longitudinal observational cohort study. Participants were enrolled between 2008 and 2011 with follow-up data collection through July 2018. Traditional risk factors associated with incident hip fracture (n = 361) included age, female sex, osteoporosis, prevalent spine and hip fracture, rheumatoid arthritis, and diabetes. Lung-specific risk factors included post-bronchodilator percent forced expiratory volume in 1 s (FEV1%) predicted (OR, 0.95; 95% CI, 0.92–0.99 for each 10% increase), Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification (OR, 1.09; 95% CI, 1.002–1.19 for each higher stage), presence of CT-determined emphysema (OR, 1.34; 95% CI, 1.06–1.69), symptom scores (OR, 1.10; 95% CI, 1.03–1.19 for each higher unit score), 6-min walk distance (OR, 0.92; 95% CI, 0.90–0.95 for each 30-m increase), body mass index, airflow obstruction, dyspnea, and exercise (BODE) index (OR, 1.07; 95% CI, 1.01–1.13 for each higher unit score), total exacerbations (OR, 1.13; 95% CI, 1.10–1.16 per exacerbation), and annual exacerbations (OR, 1.37; 95% CI, 1.21–1.55 per exacerbation). In multivariable modeling, age, black race, osteoporosis, prevalent hip and spine fracture, rheumatoid arthritis, and diabetes were associated with incident hip fracture. The presence of emphysema, 6-min walk distance, and total number of exacerbations added to traditional models improved risk discrimination (integrated discrimination improvement [IDI] values 0.001 [95% CI, 0.0003–0.002], 0.001 [95% CI, 0.0001–0.002], and 0.008 [95% CI, 0.003–0.013], corresponding to relative IDIs of 12.8%, 6.3%, and 34.6%, respectively). These findings suggest that the incorporation of lung-specific risk factors into fracture risk assessment tools may more accurately predict fracture risk in smokers. © 2020 American Society for Bone and Mineral Research.","journal":"Journal of Bone and Mineral Research","year":2020,"id":89228,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.914,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":431407,"name":"Seyed Mehdi Nouraie","orcid":null,"position":1,"is_corresponding":false},{"id":451425,"name":"Kenneth J. Smith","orcid":"0000-0001-8088-566X","position":2,"is_corresponding":false},{"id":250085,"name":"Mark T. Dransfield","orcid":"0000-0002-9207-1820","position":3,"is_corresponding":false},{"id":24993,"name":"Merry‐Lynn McDonald","orcid":"0000-0002-2647-9422","position":4,"is_corresponding":false},{"id":250090,"name":"Eric A. Hoffman","orcid":"0000-0001-8456-9437","position":5,"is_corresponding":false},{"id":350033,"name":"John D. Newell","orcid":"0000-0002-7337-5001","position":6,"is_corresponding":false},{"id":452267,"name":"Alejandro P Comellas","orcid":null,"position":7,"is_corresponding":false},{"id":326544,"name":"Punam K. Saha","orcid":"0000-0003-1576-118X","position":8,"is_corresponding":false},{"id":24947,"name":"Russell P. Bowler","orcid":"0000-0003-4651-363X","position":9,"is_corresponding":false},{"id":25009,"name":"Elizabeth A. Regan","orcid":"0000-0003-0624-9184","position":10,"is_corresponding":false},{"id":390627,"name":"Jessica Bon","orcid":"0000-0002-4336-3835","position":0,"is_corresponding":true}],"reference_count":52,"raw_metadata":null,"created_at":"2026-07-18T22:01:50.225871Z","pmid":"32754944","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}