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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\u20130.99 for each 10% increase), Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification (OR, 1.09; 95% CI, 1.002\u20131.19 for each higher stage), presence of CT-determined emphysema (OR, 1.34; 95% CI, 1.06\u20131.69), symptom scores (OR, 1.10; 95% CI, 1.03\u20131.19 for each higher unit score), 6-min walk distance (OR, 0.92; 95% CI, 0.90\u20130.95 for each 30-m increase), body mass index, airflow obstruction, dyspnea, and exercise (BODE) index (OR, 1.07; 95% CI, 1.01\u20131.13 for each higher unit score), total exacerbations (OR, 1.13; 95% CI, 1.10\u20131.16 per exacerbation), and annual exacerbations (OR, 1.37; 95% CI, 1.21\u20131.55 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\u20130.002], 0.001 [95% CI, 0.0001\u20130.002], and 0.008 [95% CI, 0.003\u20130.013], 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. \u00a9 2020 American Society for Bone and Mineral Research.<\/jats:p>","DOI":"10.1002\/jbmr.4103","type":"journal-article","created":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T04:01:43Z","timestamp":1596600103000},"page":"1952-1961","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Lung-Specific Risk Factors Associated With Incident Hip Fracture in Current and Former Smokers"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4336-3835","authenticated-orcid":false,"given":"Jessica","family":"Bon","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and VA Pittsburgh Healthcare System University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed Mehdi","family":"Nouraie","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth J","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of General Internal Medicine University of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark T","family":"Dransfield","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham, Lung Health Center Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merry-Lynn","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham, Lung Health Center Birmingham AL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering University of Iowa Iowa City IA USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City IA USA"},{"name":"Department of Radiology University of Iowa Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"John D","family":"Newell","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering University of Iowa Iowa City IA USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City IA USA"},{"name":"Department of Radiology University of Iowa Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro P","family":"Comellas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine University of Iowa Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Punam K","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering University of Iowa Iowa City IA USA"},{"name":"Department of Internal Medicine University of Iowa Iowa City IA USA"},{"name":"Department of Radiology University of Iowa Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell P","family":"Bowler","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine National Jewish Health Denver CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Regan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Rheumatology National Jewish Health Denver CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,8,4]]},"reference":[{"issue":"6","key":"2024031419514710100_jbmr4103-bib-0001","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/j.chest.2018.01.038","article-title":"Health services burden of undiagnosed and overdiagnosed COPD","volume":"153","author":"Gershon","year":"2018","journal-title":"Chest"},{"issue":"2","key":"2024031419514710100_jbmr4103-bib-0002","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1164\/rccm.201201-0034OC","article-title":"Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease","volume":"186","author":"Divo","year":"2012","journal-title":"Am J Respir Crit Care Med"},{"issue":"5","key":"2024031419514710100_jbmr4103-bib-0003","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1513\/AnnalsATS.201412-591OC","article-title":"Reduced bone density and vertebral fractures in smokers. 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