AUDIT-C Scores Greater than 7 Predict Fracture Risk

In this study, researchers surveyed US Veterans Administration (VA) patients by mail to determine whether their score on the AUDIT-C* was associated with subsequent fractures. Responses (N=32,622) ranged from 0–4 on each of the 3 AUDIT-C questions and were grouped in the following ranges: 0, 1–3, 4–5, 6–7, 8–9, and >9. Fracture data were abstracted from VA and Medicare records. Analyses of osteoporotic (i.e., hip, rib, wrist, vertebrae) versus nonosteoporotic fractures were also conducted. The majority of respondents was male (96%) and white (76%).

• After adjusting for age, education, race, and comorbidities (including smoking status), participants with AUDIT-C scores of 8–9 and >9 had a greater fracture risk (adjusted hazard ratio [HR], 1.37 and 1.79, respectively) than participants with scores of 1–3.

• Participants with AUDIT-C scores >9 had an increased risk of osteoporotic fracture compared with participants with scores of 1–3 (HR, 2.34).

• Participants with AUDIT-C scores of 6–7, 8–9, and >9 had an increased risk of nonosteoporotic fractures compared with participants with scores of 1–3 (HR, 1.42, 1.52, and 1.52, respectively).

Comments:

Validated and efficient screening tools are needed for primary care physicians to assess risk for and counsel patients about alcohol use sequelae. This new evidence of an association between AUDIT-C score and osteoporotic and other fractures provides additional support for the routine integration of alcohol screening into primary care. These findings warrant replication in face-to-face screening among a diverse primary care population.

Hillary Kunins, MD, MPH, MS

Reference:

Harris AH, Bryson CL, Sun H, et al. Alcohol screening scores predict risk of subsequent fractures. Subst Use Misuse. 2009:44(8):1055–1069.