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1.
Variation in the Efficacy of Hormone Replacement Therapy in the Prevention of Hip Fracture 总被引:3,自引:0,他引:3
K. Michaëlsson J. A. Baron O. Johnell I. Persson S. Ljunghall 《Osteoporosis international》1998,8(6):540-546
Use of postmenopausal hormone replacement therapy (HRT) has been associated with a reduced risk of osteoporotic fractures.
However, it is uncertain whether this risk reduction is modified by other risk factors for hip fracture. In a population-based
case–control study in Sweden, we investigated the association between HRT and hip fracture risk within categories of age,
body measures and lifestyle factors in postmenopausal women, 50–81 years of age. Mailed questionnaires and telephone interviews
were used to collect data. Of those eligible, 1328 incident cases with hip fracture (82.5%) and 3312 randomly selected controls
(81.6%) answered the questionnaire. Ever use of HRT in women less than 75 years old was associated with an odds ratio (OR)
of 0.66 (95% confidence interval: 95% CI 0.50–0.87) for hip fracture compared with OR 0.40 (95% CI 0.21–0.77) in women 75
years or older. We found a significant interaction between HRT and both weight and physical activity (p<0.05). The protective effect of HRT was particularly pronounced in lean women: compared with never HRT users, ever users
weighing under 60 kg had an OR of 0.44 (95% CI 0.30–0.66) whereas women weighing more than 70 kg had an OR of 0.91 (95% CI
0.53-1.-56). Women with low recent leisure physical activity (less than 1 h/week) similarly benefited more from HRT for hip
fracture prevention than women with a higher degree of recreational physical activity. The observed interactions with weight
and physical activity suggest that HRT has the best protective effect against hip fracture among high-risk women.
Received: 7 October 1997 / Revised: 21 January 1998 相似文献
2.
K. Michaëlsson E. Weiderpass B. Y. Farahmand J. A. Baron P.-G. Persson L. Zidén C. Zetterberg S. Ljunghall 《Osteoporosis international》1999,10(6):487-494
The two types of hip fracture – cervical and trochanteric femoral fractures – are generally considered together in etiologic
studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and
have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture
we used data from a large population-based case–control study in Swedish women, 50–81 years of age. Data were collected by
questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483
a trochanteric fracture during the study period; these cases were compared with 3312 randomly selected controls. Height and
hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height,
women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15–1.32) compared with an OR of 1.06 (95%
CI 0.97–1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95,
95% CI 0.91–0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current
smokers had an OR of 1.48 (95% CI 1.12–1.95) for trochanteric fractures and 1.22 (95% CI 0.98–1.52) for cervical fractures.
Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced
risk only for trochanteric fractures: OR 0.55 (95% CI 0.33–0.92) compared with 1.00 (95% CI 0.71–1.39) for cervical fractures.
These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning
preventive interventions.
Received: 22 March 1999 / Accepted: 28 May 1999 相似文献
3.
The steep rise in hip fracture incidence rates with age is not fully explained by an increase in the frequency of falls or
by reduction in bone mineral density, suggesting that circumstances of falls may also affect the risk of hip fracture. Previous
studies conducted mainly among women have identified the importance of the orientation of a fall in the etiology of hip fracture.
In this case–control study among men of 45 years and older, we evaluated how the circumstances of falls affect the risk of
hip fracture. We compared 214 cases with hip fracture due to a fall with 86 controls who had fallen within the past year but
did not sustain a hip fracture. As expected, in multivariable age-adjusted analyses men who reported hitting the hip/thigh
in a fall had a markedly elevated risk of hip fracture (OR = 97.8; 95% CI = 31.7–302). Hitting the knee in a fall was associated
with reduced risk (OR = 0.24; 95% CI = 0.09–0.67). Other factors that were associated with reduced risk of hip fracture among
men who fell were more hours of physical activity in the past year (OR = 0.84; 95% CI = 0.73–0.97, for each additional 4 h
per week), a greater body mass index (OR = 0.60; 95% CI = 0.40–0.90, for each additional 4 kg/m2), and a history of a fracture when age 45 years or older (OR = 0.26; 95% CI = 0.10–0.69). Reported lower limb dysfunction
was associated with increased risk of hip fracture (OR = 6.41; 95% CI = 2.09–19.6) among fallers. The increased risk associated
with hitting the hip/thigh in a fall and the reduced risk associated with high body mass index suggest that preventive efforts
for older men at high risk might include protective hip pads to reduce the force on the hip in a fall. Exercise and strength
training programs may also reduce the risk of hip fracture among men who fall.
Received: 12 May 1997 / Accepted: 14 October 1997 相似文献
4.
Femoral Neck and Intertrochanteric Fractures Have Different Risk Factors: A Prospective Study 总被引:3,自引:0,他引:3
The aim of this study was to determine whether both types of hip fracture, femoral neck and intertrochanteric, have similar
risk factors. A prospective cohort study was carried out on community-dwelling elderly women in four areas of the United States:
Baltimore, MD; Pittsburgh, PA; Minneapolis, MN and Portland, OR. The participants were 9704 Caucasian women, 65 years and
older, of whom 279 had fractured their femoral neck and 222 had fractured their trochanteric region of the proximal femur.
The predictors used were the bone mass of the calcaneus and proximal femur, anthropometry, history of fracture (family and
personal), medication use, functional status, physical activity and visual function. The main outcome measures were femoral
neck and intertrochanteric fractures occurring during an average of 8 years of follow-up. In multivariate proportional hazards
models, several risk factors increased the risk of both types of hip fracture; including femoral neck bone density and increased
functional difficulty. In hazard regression models that directly compared risk factors for the two types of hip fracture,
calcaneal bone mineral density (BMD) predicted femoral neck fractures more strongly than intertrochanteric fractures (OR =
1.16; 95% CI = 1.02–1.31). Steroid use and impaired functional status also predicted femoral neck fractures instead of intertrochanteric
fractures. Poor health status (OR = 0.74; 95% CI = 0.55–1.00) predicted intertrochanteric fractures more strongly than femoral
neck fractures. We conclude that femoral neck fractures are largely predicted by BMD and poor functional ability while aging
and poor health status predispose to intertrochanteric fractures.
Received: 8 February 2000 / Accepted: 10 June 2000 相似文献
5.
Prevalent Vertebral Deformity Predicts Incident Hip though not distal Forearm Fracture: Results from the European Prospective Osteoporosis Study 总被引:5,自引:5,他引:5
A. A. Ismail W. Cockerill C. Cooper J. D. Finn K. Abendroth G. Parisi D. Banzer L. I. Benevolenskaya A. K. Bhalla J. Bruges Armas J. B. Cannata P. D. Delmas J. Dequeker G. Dilsen R. Eastell O. Ershova J. A. Falch B. Felsch S. Havelka K. Hoszowski I. Jajic U. Kragl O. Johnell A. Lopez Vaz R. Lorenc G. Lyritis F. Marchand P. Masaryk C. Matthis T. Miazgowski H. A. P. Pols G. Poor A. Rapado H. H. Raspe D. M. Reid W. Reisinger J. Janott C. Scheidt-Nave J Stepan C. Todd K. Weber A. D. Woolf G. Ambrecht W. Gowin D. Felsenberg M. Lunt J. A. Kanis J. Reeve A. J. Silman T. W. O’Neill 《Osteoporosis international》2001,12(2):85-90
The presence of a vertebral deformity increases the risk of subsequent spinal deformities. The aim of this analysis was to
determine whether the presence of vertebral deformity predicts incident hip and other limb fractures. Six thousand three hundred
and forty-four men and 6788 women aged 50 years and over were recruited from population registers in 31 European centers and
followed prospectively for a median of 3 years. All subjects had radiographs performed at baseline and the presence of vertebral
deformity was assessed using established morphometric methods. Incident limb fractures which occurred during the follow- up
period were ascertained by annual postal questionnaire and confirmed by radiographs, review of medical records and personal
interview. During a total of 40 348 person-years of follow-up, 138 men and 391 women sustained a limb fracture. Amongst the
women, after adjustment for age, prevalent vertebral deformity was a strong predictor of incident hip fracture, (rate ratio
(RR) = 4.5; 95% CI 2.1–9.4) and a weak predictor of ‘other’ limb fractures (RR = 1.6; 95% CI 1.1–2.4), though not distal forearm
fracture (RR = 1.0; 95% CI 0.6–1.6). The predictive risk increased with increasing number of prevalent deformities, particularly
for subsequent hip fracture: for two or more deformities, RR = 7.2 (95% CI 3.0–17.3). Amongst men, vertebral deformity was
not associated with an increased risk of incident limb fracture though there was a nonsignificant trend toward an increased
risk of hip fracture with increasing number of deformities. In summary, prevalent radiographic vertebral deformities in women
are a strong predictor of hip fracture, and to a lesser extent humerus and ‘other’ limb fractures; however, they do not predict
distal forearm fractures.
Received: 23 February 2000 / Accepted: 11 August 2000 相似文献
6.
T. S. Wei C. H. Hu S. H. Wang K. L. Hwang
Departments of 《Osteoporosis international》2001,12(12):1050-1055
Hip fracture is the most serious consequence of osteoporosis, frequently occurring in the elderly; however, no research has
been performed to identify the fall characteristics, functional mobility and bone mineral density (BMD) concurrently as risk
factors. We investigated the risk factors of hip fractures using a multifactorial approach for a further preventive strategy.
This age- and sex-matched case-control study was conducted in a community-based general hospital. A total of 252 consecutive
community-dwelling ambulatory elderly, aged between 65 and 85 years, were studied: 127 patients (faller with hip fracture)
and 125 controls (faller without hip fracture). Body mass index (BMI), predisposing medical conditions, fall characteristics,
functional mobility and BMD of the hip were evaluated by direct interview and clinical examination. In the final model of
multivariate regression analysis, risk factors for hip fracture were direct hip impact (adjusted odds ratio (OR), 4.9; 95%
confidence interval (CI), 2.7–8.8), previous stroke (adjusted OR, 2.9; 95% CI, 1.3–6.3), sideways fall (adjusted OR, 2.5;
95% CI, 1.6–3.9), functional mobility (a decrease of 1 SD; adjusted OR, 2.0; 95% CI, 1.1–3.5), BMI (a decrease of 1 SD; adjusted
OR, 1.8; 95% CI, 1.1–2.8) and femoral neck BMD (a decrease of 1 SD; adjusted OR, 1.7; 95% CI, 1.0–2.8). The effect of risk
factors remained the same in different analysis sets, and adding or removing femoral neck BMD did not change other risk factors,
though BMD was significantly correlated with functional mobility and BMI. Importantly, both sideways fall and direct hip impact
are independent predictors of hip fracture. From these results, we suggest a preventive strategy of hip fracture in the elderly:
besides the maintenance of BMD, keeping an appropriate body weight and maintaining a physically active lifestyle might be
crucial.
Received: 11 January 2001 / Accepted: 6 July 2001 相似文献
7.
Proximal Femur Geometry To Detect and Distinguish Femoral Neck Fractures from Trochanteric Fractures in Postmenopausal Women 总被引:19,自引:4,他引:15
S. Gnudi C. Ripamonti L. Lisi M. Fini R. Giardino G. Giavaresi 《Osteoporosis international》2002,13(1):69-73
Some proximal femur geometry (PFG) parameters, measured by dual-energy X-ray absorptiometry (DXA), have been reported to
discriminate subjects with hip fracture. Relatively few studies have tested their ability to discriminate femoral neck fractures
from those of the trochanter. To this end we performed a cross-sectional study in a population of 547 menopausal women over
69 years of age with femoral neck fractures (n= 88), trochanteric fractures (n= 93) or controls (n= 366). Hip axis length (HAL), neck–shaft angle (NSA), femoral neck diameter (FND) and femoral shaft diameter (FSD) were measured
by DXA, as well as the bone mineral density (BMD) of the nonfractured hip at the femoral neck, trochanter and Ward’s triangle.
In fractured subjects, BMD was lower at each measurement site. HAL was longer and NSA wider in those with femoral neck fractures.
With logistic regression the age-adjusted odds ratio (OR) for a 1 standard deviation (SD) decrease in BMD was significantly
associated at each measurement site with femoral neck fracture (femoral neck BMD: OR 1.9, 95% confidence interval (95% CI):
1.4–2.5; trochanter BMD: OR 1.6, 95% CI 1.2–2.0; Ward’s triangle BMD: OR 1.7, 95% CI 1.3–2.2) and trochanteric fracture (femoral
neck BMD: OR 2.6, 95% CI 1.9–3.6; trochanter BMD: OR 3.0, 95% CI 2.2–4.1; Ward’s triangle BMD: OR 1.8, 95% CI 1.4–2.3). Age-adjusted
OR for 1 SD increases in NSA (OR 2.2, 95% CI 1.7–2.8) and HAL (OR 1.3, 95% CI 1.1–1.6) was significantly associated with the
fracture risk only for femoral neck fracture. In the best predictive model the strongest predictors were site-matched BMD
for both fracture types and NSA for neck fracture. Trochanteric BMD had the greatest area (0.78, standard error (SE) 0.02)
under the receiver operating characteristic curve in trochanteric fractures, whereas for NSA (0.72, SE 0.03) this area was
greatest in femoral neck fractures. These results confirm the association of BMD with proximal femur fracture and support
the evidence that PFG plays a significant role only in neck fracture prediction, since NSA is the best predictive parameter
among those tested.
Received: 24 April 2001 / Accepted: 1 August 2001 相似文献
8.
Socioeconomic Status, Marital Status and Hip Fracture Risk: A Population-Based Case–Control Study 总被引:3,自引:0,他引:3
B. Y. Farahmand P.-G. Persson K. Michaëlsson J. A. Baron M. G. Parker S. Ljunghall 《Osteoporosis international》2000,11(9):803-808
Socioeconomic status and social support have been identified as important determinants of several diseases and overall mortality,
but these factors have not been adequately examined in relation to hip fracture risk. The aim of this study was to determine
the relationship of socioeconomic status and marital status to hip fracture risk. We used data from a population-based case–control
study in postmenopausal women aged 50–81 years during 1993–1995 who resided in six counties in Sweden. The analysis was based
on 1327 incident cases of hip fracture and 3262 randomly selected controls. Socioeconomic and marital status were obtained
by record linkage with census data in 1960, 1970, 1980 and 1990. Information on other possible risk factors for hip fracture
was collected by a mailed questionnaire. Women who were gainfully employed in 1990 had an odds ratio (OR) of 0.74 [95% confidence
interval (CI) 0.56–0.96] compared with those not gainfully employed; those in the highest tertile of household income had
an OR of 0.74 (95% CI 0.60–0.90) compared with those in the lowest tertile of income. Women who lived in a one-family house
had an OR of 0.85 (95% CI 0.72–0.99) compared with those living in an apartment. Divorced, widowed or unmarried women had
a higher risk of hip fracture than married or cohabiting women; the OR was 1.40 (95% CI 1.06–1.85). Married women who were
both gainfully employed and were living in a one-family house had a substantially decreased risk of hip fracture compared
with unemployed women living without a partner in an apartment (OR 0.39; 95% CI 0.22–0.71). Occupational affiliation among
women ever employed, and educational level, were not associated with hip fracture risk. We conclude that employment, household
income, type of housing and marital status seem to be risk indicators of hip fracture risk independent of known osteoporotic
risk factors.
Received: 6 October 1999 / Accepted: 29 March 2000 相似文献
9.
The ability of quantitative ultrasound (QUS) to estimate the risk of osteoporotic fractures was evaluated in a prospective
study over a mean time of 5.47 years in 254 postmenopausal women (mean age 58.06 ± 7.67 years). Baseline measurements of ultrasound
transmission velocity (UTV) and bone mineral density (BMD) were taken at the distal radius (DR). UTV was also measured at
the patella (P). Fifty nonspine fractures due to minor trauma were detected during annual check-ups with an incidence of 3.59/year.
Fractures occurred in older women with a lower BMD and QUS. Using Cox regression analysis the relative risk (RR) per 1 standard
deviation (SD) decrease in the unadjusted QUS and BMD measurements was: BMD-DR = 3.56, 95% confidence interval (CI) 1.57–8.09;
UTV-DR = 5.35, 95% CI 2.07–13.83; UTV-P = 4.49, 95% CI 2.08–9.68. The relationship between BMD and QUS variables and fracture
risk persisted after adjusting for potential confounders apart from previous fractures, giving the following RR: BMD-DR =
2.99, 95% CI 1.06–8.41; UTV-DR = 3.69, 95% CI 1.18–11.49; UTV-P = 3.89, 95% CI 1.53–9.90. Correcting also for previous fractures,
only UTV-P remained an effective predictor of fracture risk even after QUS measurement correction for BMD. Wrist fractures
were best related to BMD-DR (RR 7.33, 95% CI 1.43–37.50) and UTV-DR (RR 10.94, 95% CI 1.10–108.45), while hip and ankle fractures
were significantly associated only with UTV-P (hip: RR 32.14, 95% CI 1.83–562.80; ankle: RR 17.60, 95% CI 1.78–173.79). The
combined use of BMD and QUS is a better predictor of fracture risk than either technique used separately. Comparison of the
areas under the receiver operating characteristic (ROC) curves did not show differences in the ability of BMD and QUS to correctly
distinguish fractures. In conclusion, QUS predicts fracture risk in osteoporotic women at least as well as BMD. UTV-DR and
BMD-DR are good predictors of wrist fractures, while UTV-P is strongly related to hip and ankle fractures. QUS and BMD combined
improve the diagnostic ability of each technique individually.
Received: 27 April 1999 / Accepted: 3 December 1999 相似文献
10.
Forearm Fractures as Predictors of Subsequent Osteoporotic Fractures 总被引:11,自引:0,他引:11
M.-T. Cuddihy S. E. Gabriel C. S. Crowson W. M. O’Fallon L. J. Melton III 《Osteoporosis international》1999,9(6):469-475
To assess the ability of distal forearm fractures to predict future fractures, we conducted a population-based retrospective
cohort study among the 1288 residents (243 men, 1045 women) of Rochester, Minnesota age 35 years or older who experienced
their first distal forearm fracture in 1975–94. During 9664 person-years of follow-up, 548 patients experienced 1109 subsequent
fractures, excluding 195 that occurred on the same day as the index forearm fracture. The cumulative incidence of any subsequent
fracture was 55% by 10 years and 80% by 20 years following the initial distal forearm fracture. Compared to expected fracture
rates in the community, the risk of a hip fracture following the index forearm fracture was increased 1.4-fold in women (95%
CI, 1.1–1.8) and 2.7-fold in men (95% CI, 0.98–5.8). In women, the risk of hip fracture differed by age, as we had found in
a previous study. Women over age 70 had a 1.6-fold increase (95% CI, 1.2–2.0) in subsequent hip fracture risk whereas women
who sustained their first forearm fracture before age 70 years did not have significantly increased risk. By contrast, vertebral
fractures were significantly increased at all ages, with a 5.2-fold increase (95% CI, 4.5–5.9) in risk among women and a 10.7-fold
increase (95% CI, 6.7–16.3) among men following a first distal forearm fracture. The increased risk in men suggests that a
sentinel forearm fracture should not be ignored. Among the women, we also found a missed opportunity for intervention as hormone
replacement therapy was underutilized.
Received: 8 May 1998 / Accepted: 16 October 1998 相似文献
11.
Risk Factors for Perimenopausal Fractures: A Prospective Study 总被引:11,自引:6,他引:5
J. Huopio H. Kröger R. Honkanen S. Saarikoski E. Alhava 《Osteoporosis international》2000,11(3):219-227
This prospective study was aimed at determining the risk factors for the development of fractures in perimenopausal women.
The study group (n= 3068) was comprised of a stratified population sample of women aged between 47 and 56 years. During the follow-up period
of 3.6 years, 257 (8.4%) of the women sustained a total of 295 fractures. After adjustment for covariates, the relative risk
(RR) of sustaining a fracture was found to be 1.4 [95% confidence interval (CI) 1.2–1.6] for a 1 standard deviation (SD) decrease
in the spinal and femoral neck bone mineral density (BMD). Women with a previous fracture history were found to have an increased
risk of fracture [RR 1.7 (95% CI 1.3–2.2)] and those reporting three or more chronic illnesses exhibited a RR of 1.4 (95%
CI 1.0–1.9). Women not using hormone replacement therapy (HRT) had a RR of 1.5 (95% CI 1.1–2.2) for all fracture types. When
osteoporotic fractures (vertebral, hip, proximal humerus and wrist fractures; n= 98) were used as an endpoint, the independent risk factors were found to be a low BMD (RR for a 1 SD decrease in both spinal
and femoral neck BMD was 1.6, 95% CI 1.3–2.0), a previous fracture history (RR 1.9, 95% CI 1.3–2.9) and nonuse of HRT (RR
2.2, 95% CI 1.3–4.0). The independent risk factors for all other fractures (n = 158) were a low BMD (RR for a 1 SD decrease in the spinal BMD was 1.4, 95% CI 1.2–1.6 and in the femoral neck BMD was 1.3,
95% CI 1.1–1.5), a previous fracture history (RR 1.6, 95% CI 1.1–2.2), smoking (RR 1.8, 95% CI 1.1–2.7) and having had three
or more chronic illnesses (RR 1.6, 95% CI 1.1–2.2). Weight, height, age, menopausal status, maternal hip fracture, use of
alcohol, coffee consumption or dietary calcium intake were not independently associated with the development of any particular
type of fracture. We conclude that the independent risk factors for perimenopausal fractures are a low bone density, previous
fracture history, nonuse of HRT, having had three or more chronic illnesses and smoking, the gradient of risk being similar
for spinal and femoral neck BMD measurements in the perimenopausal population. The risk factors are slightly different for
perimenopausal osteoporotic than for other types of fractures.
Received: 6 April 1999 / Accepted: 18 August 1999 相似文献
12.
Vertebral Fractures Predict Subsequent Fractures 总被引:18,自引:5,他引:13
L. J. Melton III E. J. Atkinson C. Cooper W. M. O’Fallon B. L. Riggs 《Osteoporosis international》1999,10(3):214-221
This population-based study documents an increase in most types of fractures following the occurrence of a clinically recognized
vertebral fracture among 820 Rochester, Minnesota, residents. During 4349 person-years of follow-up, 896 new fractures were
observed. Relative to incidence rates in the community, there was a 2.8-fold increase in the risk of any fracture, which was
greater in men (standardized incidence ratio (SIR), 4.2; 95% CI, 3.2–5.3) than women (SIR, 2.7; 95% CI, 2.4–3.0). The estimated
cumulative incidence of any fracture after 10 years was 70%. The greatest increase in risk was for subsequent fractures of
the axial skeleton, in particular a 12.6-fold increase (95% CI, 11–14) in additional vertebral fractures. There was a lesser
increase in most limb fractures, including a 2.3-fold increase (95% CI, 1.8–2.9) in hip fractures and a 1.6-fold increase
(95% CI, 1.01–2.4) in distal forearm fractures. There was a slightly greater association with distal forearm fractures among
those whose first vertebral fracture occurred before age 70 years but a similar relationship with hip fractures, including
cervical and intertrochanteric hip fractures separately, regardless of age at the initial vertebral fracture. There was also
an equivalent increase in subsequent fracture risk whether the initial vertebral fracture was attributed to severe or moderate
trauma. These data show that vertebral fractures represent an important risk factor for fractures in general, not just those
of the spine and hip.
Received: 2 September 1998 / Accepted: 9 February 1999 相似文献
13.
Predictors of Fractures in Elderly Women 总被引:21,自引:0,他引:21
A. M. Tromp M. E. Ooms C. Popp-Snijders J. C. Roos P. Lips 《Osteoporosis international》2000,11(2):134-140
In a prospective study of 348 apparently healthy women, aged 70 years and over (mean 80.3 years), we examined bone mineral
density (BMD), biochemical markers of bone metabolism, and some easily measurable predictors in relation to hip and osteoporotic
fractures. In addition, we constructed risk profiles for hip and osteoporotic fractures. At baseline, BMD at both hips, using
dual-energy X-ray absorptiometry, body height and body weight were measured. At the same time, serum and urine samples were
obtained for biochemical analysis. Serum samples were analyzed for vitamin D metabolites, sex hormone binding globulin, serum
intact parathyroid hormone, osteocalcin, alkaline phosphatase, phosphate, albumin, calcium and creatinine. In 2 h fasting
urine, hydroxyproline, type I collagen crosslinked N-telopeptide (NTx) and calcium excretion were measured. Furthermore, easily
measurable predictors, such as previous fracture, body mass index (BMI) and mobility were assessed. During the follow-up period
(mean duration 5.0 years), hip and any osteoporotic fracture (wrist, humerus or hip fracture) occurred in 16 and 33 participants,
respectively. Data were analyzed using Cox regression analysis. BMD of the trochanter (per 1 SD decrease) and previous fracture
were most strongly associated with hip fractures (adjusted relative risk (RR) = 3.0, 95% confidence interval (CI): 1.4–6.6;
RR = 4.2, 95% CI: 1.5–11.6, respectively) and osteoporotic fractures (RR = 1.8, 95% CI: 1.1–2.8; RR = 2.9, 95% CI: 1.5–5.7,
respectively). Previous fracture, BMI and mobility were identified as easily measurable predictors for hip fractures, whereas
previous fracture, use of loop diuretics and age were predictors for osteoporotic fractures in the risk profile model. The
risk of fractures can be predicted with three easily measurable predictors. This study confirms the importance of previous
fracture as a predictor for hip fractures and other fractures. It also shows that the use of loop diuretics is a predictor
for osteoporotic fractures.
Received: 28 January 1999 / Accepted: 29 June 1999 相似文献
14.
Symptomatic fractures are a significant problem in terms of both morbidity and financial cost. Marked variation in both total
and site-specific fracture incidence has been documented internationally but there is limited within-country data. This prospective
population-based study documented the incidence of all symptomatic fractures occurring from July 1, 1997 to June 30, 1999
in adults ≥50 years of age resident in Southern Tasmania (total population ≥50 years: 64 688). Fractures were ascertained
by reviewing reports from all the radiology providers within the area. There were 701 fractures in men and 1309 fractures
in women. The corresponding fracture incidence in men and women was 1248 and 1916 per 100 000 person-years, respectively.
Residual lifetime fracture risk in a person aged 50 years was 27% for men and 44% for women with fractures other than hip
fractures constituting the majority of symptomatic fracture events. These fracture risk estimates remained remarkably constant
with increasing age. In comparison to Geelong, there were significantly lower hip fracture rates (males: RR 0.59, 95% CI 0.45–0.76;
females: RR 0.61, 95% CI 0.53–0.71) but significantly higher distal forearm fractures (males: RR 1.87, 95% CI 1.10–3.78; females:
RR 1.31, 95% CI 1.11–1.55) and total fractures in men (RR 1.31, 95% CI 1.17–1.46) but not women (RR 1.05, 95% CI 0.98–1.13).
In contrast, Southern Tasmania had lower age-standardized rates of all fractures compared with Dubbo (RR 0.28–0.79). In conclusion,
this study provides compelling evidence that fracture incidence varies between different geographic sites within the same
country, which has important implications for health planning. In addition, the combination of high residual fracture risk
and short life expectancy in elderly subjects suggests fracture prevention will be most cost-effective in later life.
Received: 27 April 2000 / Accepted: 16 August 2000 相似文献
15.
A. N. A. Tosteson S. E. Gabriel M. R. Grove M. M. Moncur T. S. Kneeland L. J. Melton III 《Osteoporosis international》2001,12(12):1042-1049
The objective of the study was to estimate the impact of hip and vertebral fractures on quality of life in postmenopausal
women using a preference-based health measure that is appropriate for economic evaluations and to investigate correlates of
health outcome. Interviews to assess health-related quality of life, which also documented other health conditions and characteristics,
were undertaken in women age 50 years and older without osteoporotic fractures compared with women with hip and/or vertebral
fracture(s). Health status was characterized by self-reported physical limitations and the mental and physical component summary
scores of the SF-36. Quality-adjusted life years (QALYs), which reflect each individual’s assessment of her overall health
utility, were estimated with time tradeoff values. Regression methods were used to examine QALY correlates (e.g. time since
fracture) for each fracture group and to estimate differences in QALYs between fracture and non-fracture subjects after accounting
for other patient characteristics. Among 382 women ages 50–96 years, fracture subjects were significantly older, less likely
to use hormone replacement therapy and more likely to report physical limitations than non-fracture subjects. On the QALY
scale, where 1 represents perfect health and 0 represents death, mean QALY values were 0.82 (95% CI: 0.76, 0.87) among 114
women with one or more vertebral fractures and 0.63 (95% CI: 0.52, 0.74) among 67 with hip fracture compared with 0.91 (95%
CI: 0.88, 0.94) among 201 women without fracture. No significant correlates of QALYs were identified among women with vertebral
fracture alone. Among hip fracture subjects, time since hip fracture and presence of a vertebral fracture were significant
correlates of QALYs. In multiple regression analyses, estimated QALY differences (fracture minus non-fracture subjects) ranged
from –0.05 to –0.55 and were equivalent to losses of 20–58 days, 23–65 days and 115–202 days per year for vertebral fracture
(p= 0.001), hip fracture (p= 0.009) and hip plus vertebral fracture (p<0.001) subjects, respectively, depending on age. Thus to adequately assess the cost-effectiveness of osteoporosis treatment,
the negative impact of vertebral fractures on QALYs, even among women who have survived a hip fracture, must be considered.
Received: 2 February 2001 / Accepted: 23 July 2001 相似文献
16.
Ultrasound Measurements for the Prediction of Osteoporotic Fractures in Elderly People 总被引:13,自引:7,他引:6
In this prospective study we investigated the predictive value of quantitative ultrasound (QUS) measurements and other potential
predictors of osteoporotic fractures in the elderly. During a 1-year period, 710 participants (132 men and 578 women), aged
70 years and older (mean age ± SD: 82.8 ± 5.9), were recruited from seven homes and apartment houses for the elderly. QUS
measurements (broadband ultrasound attenuation (BUA) and speed of sound (SOS)) were assessed with a clinical bone densitometer.
A structured questionnaire was used to collect information on other potential predictors. Follow-up of fractures was done
each half year by telephone interviews. During the study period (median follow-up 2.8 years, maximum 3.7 years), 30 participants
had a first hip fracture and 54 suffered from a first other nonspinal fracture. Cox regression analyses, adjusted for age
and sex, showed that the relative risk (RR) of hip fracture for each standard deviation reduction was 2.3 (95% CI, 1.4–3.7)
for BUA and 1.6 (95% CI, 1.1–2.3) for SOS. Slightly weaker relationships were found for any fracture (BUA: RR, 1.6; 95% CI,
1.2–2.1; SOS: RR, 1.3; 95% CI, 1.0–1.6). Multivariable analyses identified low BUA values and immobility as the strongest
predictors for hip fractures and any fracture. Female gender proved to be the strongest predictor for other nonspinal fractures.
It can be concluded that QUS measurements can predict the risk for hip fracture and any fracture in elderly people.
Received: 23 July 1998 / Accepted: 19 November 1998 相似文献
17.
Survival after Hip Fracture: Short- and Long-Term Excess Mortality According to Age and Gender 总被引:5,自引:5,他引:0
L. Forsén A. J. Søgaard H. E. Meyer T.-H. Edna B. Kopjar 《Osteoporosis international》1999,10(1):73-78
The purpose of this study was to analyze the excess mortality after hip fracture and to reveal whether, and eventually when,
the excess mortality vanished in different groups of age and gender. A population-based, prospective, matched-pair, cohort
study among persons 50 years of age and older was conducted involving 1338 female and 487 male hip fracture patients with
11 086 and 8141 controls respectively. Occurrence of hip fracture and mortality were recorded from 1986 until 1995. We studied
the excess mortality of the hip fracture patients versus controls by using Kaplan–Meier curves and extended Cox regression
with hip fracture (yes/no) as time-dependent covariate. The male hip fracture patients had higher mortality than the women
the first year after the injury, irrespective of age, both in absolute terms (31% and 17% respectively) and relative to their
age-matched controls. The relative risk (RR) of dying within 1 year for hip fracture patients versus controls was 3.3 (95%
confidence interval (CI) 2.1–5.2) for women and 4.2 (95% CI 2.8–6.4) for men below 75 years of age. The corresponding figures
for persons 85 years and older were 1.6 (95% CI 1.2–2.0) for women and 3.1 (95% CI 2.2–4.2) for men. All groups of age and
gender, except women 85 years and older, had a large and significant excess mortality lasting for many years after the hip
fracture – at least 5–6 years for women below 75 years of age (RR = 3.2, 95% CI 1.9–5.6). The excess mortality after hip fracture
for women 85 years and older had vanished after 3 months (RR = 1.0, 95% CI 0.8–1.1). When referring to the excess mortality
after hip fracture it is therefore necessary to specify sex, age and time since injury.
Received: 15 September 1998 / Accepted: 23 December 1998 相似文献
18.
Unbalanced Diet to Lower Serum Cholesterol Level is a Risk Factor for Postmenopausal Osteoporosis and Distal Forearm Fracture 总被引:1,自引:1,他引:0
M. Varenna L. Binelli F. Zucchi D. Ghiringhelli L. Sinigaglia 《Osteoporosis international》2001,12(4):296-301
The purpose of this study was to assess whether dietary changes aimed at reducing serum cholesterol can increase the risk
of osteoporosis (OP) and fracture. The study group consisted of 311 postmenopausal women with high serum cholesterol levels
and following a diet low in dairy products (calcium intake estimated at less than 300 mg/day) for 27.3 ± 29.1 months. This
sample was compared with a case–control group of 622 healthy postmenopausal women paired for age and age at menopause and
with a calcium intake estimated at more than 1 g/day. Bone mineral density was measured at the lumbar spine by dual-energy
X-ray absorptiometry. Prevalence of OP was significantly higher in women with a low dairy calcium intake (42.1% vs 22.3%; p<0.0001), as was the number of Colles” fractures occurring after menopause (4.5% vs 1.6%; p = 0.008). Multiple logistic regression analyses demonstrated that a diet low in dairy calcium was a risk factor for OP (OR
= 2.52, 95% CI 1.84–3.45) and Colles” fracture (OR = 2.72, 95% CI 1.18–6.26). In the low dairy calcium group, diet duration
significantly influenced the risk of OP (OR = 1.13, 95% CI 1.01–1.25 for 1 year of diet). No differences in further risk factors
for coronary heart disease were found between the groups, but the proportion of women physically active was lower in the women
with high serum cholesterol levels. A diet that severely limits calcium intake from dairy products in an attempt to correct
raised serum cholesterol levels is a risk factor for postmenopausal OP and Colles” fracture. Dietary intervention methods
to lower serum cholesterol in postmenopausal women should maintain an adequate calcium intake by providing calcium from low-fat
dairy products or calcium supplements.
Received: 16 May 2000 / Accepted: 18 November 2000 相似文献
19.
Factors Associated with Mortality after Hip Fracture 总被引:4,自引:0,他引:4
There is a well-known excess mortality subsequent to hip fracture, which is probably restricted to subgroups of hip fracture
patients with reduced health status. We studied the association between risk factors and death in 248 hip fracture patients
and 248 controls originally enrolled in a population-based case–control study. This cohort was followed for 3 1/2 years with
respect to total mortality. A markedly increased mortality was found in hip fracture patients passing a mental status test
at a low score [relative risk (RR) = 2.3, 95% confidence interval (CI) 1.4-3.7], in hip fracture patients reporting two or
more selected chronic diseases (RR = 3.3, 95% CI 1.8–6.1), in hip fracture patients not walking outdoors before the fracture
(RR = 3.2, 95% CI 2.0–5.1) and in hip fracture patients in the lower half of handgrip strength distribution (RR = 2.3, 95%
CI 1.6–3.4), all compared with the control group. In contrast, hip fracture patients without these risk factors did not have
increased mortality compared with the control group. This study suggests that otherwise healthy and fit patients do not have
increased mortality subsequent to hip fracture. The excess mortality is restricted to persons with reduced mental status,
reduced somatic health and low physical ability. Special attention should be paid to patients with such risk factors in the
treatment and rehabilitation period.
Received: 2 March 1999 / Accepted: 17 August 1999 相似文献
20.
Femoral Bone Mineral Density, Neck-Shaft Angle and Mean Femoral Neck Width as Predictors of Hip Fracture in Men and Women 总被引:19,自引:6,他引:13
C. Gómez Alonso M. Díaz Curiel F. Hawkins Carranza R. Pérez Cano A. Díez Pérez 《Osteoporosis international》2000,11(8):714-720
The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck–shaft
angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All
parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60–90 years)
with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women;
aged 60–90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly
lower, and neck–shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic
regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck
BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45
(95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck–shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95%
CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40
(95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except
for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.
Received: 16 September 1999 / Accepted: 22 February 2000 相似文献