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American Journal of Epidemiology Advance Access originally published online on December 8, 2008
American Journal of Epidemiology 2009 169(2):150-152; doi:10.1093/aje/kwn378
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Invited Commentary

Invited Commentary: A Fine Balance—Weighing Risk Factors Against Risk

Michael G. Walsh

Correspondence to Dr. Michael G. Walsh, Departments of Environmental Medicine and Orthopaedic Surgery, Division of Outcomes Studies, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016 (e-mail: thegowda{at}gmail.com).

Received for publication July 25, 2008. Accepted for publication July 29, 2008.

Fracture is a leading cause of disability in the aging population. Because the cost of fracture in terms of medical expenditures and quality of life lost can be substantial, it is essential to identify a complete profile of fracture risk for the development of timely interventions. Risk factors for fracture have most often been identified clinically. Thus, the contribution by Wagner et al. in this issue of the Journal is particularly important, since it demonstrates a robust association between balance impairment and fracture in a population-based setting. It is unclear, however, whether isolating balance as a risk factor can tell us enough about the clustering of risk factors for fracture that accompanies frailty. Indeed, this problem of risk clustering is one that epidemiologists often encounter as we try to locate the mediating processes between exposures and outcomes that lead downstream through complex interacting causal pathways. In this commentary, the author discusses the importance, particularly when studying frailty and fracture, of quantifying risk clustering rather than continuing to rely on solitary risk factors. Moreover, the author suggests the use of Bayesian networks in the expansion of our tool kit in this field of research.

accidental falls; bone and bones; fractures, bone; frail elderly; musculoskeletal equilibrium; osteoporosis; risk factors; twins

Abbreviations: CI, confidence interval; DAG, directed acyclic graph; RR, relative risk


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Related articles in Am. J. Epidemiol.:

Simply Ask Them About Their Balance—Future Fracture Risk in a Nationwide Cohort Study of Twins
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Am. J. Epidemiol. 2009 169: 143-149. [Abstract] [FREE Full Text]  





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