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1.
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
2.
A. A. Ismail T. W. O'Neill C. Cooper J. D. Finn A. K. Bhalla J. B. Cannata P. Delmas J. A. Falch B. Felsch K. Hoszowski O. Johnell J. B. Diaz-Lopez A. Lopes Vaz F. Marchand H. Raspe D. M. Reid C. Todd K. Weber A. Woolf J. Reeve A. J. Silman 《Osteoporosis international》1998,8(3):291-297
Clinically apparent vertebral deformities are associated with reduced survival. The majority of subjects with radiographic
vertebral deformity do not, however, come to medical attention. The aim of this study was to determine the association between
radiographic vertebral deformity and subsequent mortality. The subjects who took part in the analysis were recruited for participation
in a multicentre population-based survey of vertebral osteoporosis in Europe. Men and women aged 50 years and over were invited
to attend for an interviewer-administered questionnaire and lateral spinal radiographs. Radiographs were evaluated morphometrically
and vertebral deformity defined according to established criteria. The participants have been followed by annual postal questionnaire
– the European Prospective Osteoporosis Study (EPOS). Information concerning the vital status of participants was available
from 6480 subjects, aged 50–79 years, from 14 of the participating centres. One hundred and eighty-nine deaths (56 women and
133 men) occurred during a total of 14 380 person-years of follow-up (median 2.3 years). In women, after age adjustment, there
was a modest excess mortality in those with, compared with those without, vertebral deformity: rate ratio (RR) = 1.9 (95%
confidence interval (CI) 1.0,3.4). In men, the excess risk was smaller and non-significant RR = 1.3 (95% CI 0.9,2.0). After
further adjusting for smoking, alcohol consumption, previous hip fracture, general health, body mass index and steroid use,
the excess risk was reduced and non-significant in both sexes: women, RR = 1.6 (95% CI 0.9,3.0); men RR = 1.2 (95% CI 0.7,1.8).
Radiographic vertebral deformity is associated with a modest excess mortality, particularly in women. Part of this excess
can be explained by an association with other adverse health and lifestyle factors linked to mortality.
Received: 12 June 1997 / Accepted: 6 November 1997 相似文献
3.
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
4.
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
5.
John T Schousboe Howard A Fink Li-Yung Lui Brent C Taylor Kristine E Ensrud 《Journal of bone and mineral research》2006,21(10):1557-1564
In this large cohort of elderly women, prior non-spine non-hip fractures and radiographic vertebral deformities >10 years old were modestly associated with incident hip fracture, but the excess risks of hip fracture attributable to those prior fractures and deformities seem to wane over time. INTRODUCTION: Whereas prior clinical fractures and prevalent radiographic vertebral deformities are well-documented predictors of incident hip fracture, the excess risks of incident fractures attributable to those prior fractures and deformities may decrease over time. Current guidelines regarding the assessment of fracture risk do not consider elapsed time since prior fracture or ascertainment of radiographic vertebral deformity. MATERIALS AND METHODS: We ascertained self-reported history of prior clinical fractures and calcaneal and total hip bone BMD and performed lateral spine radiographs in a cohort of 9516 community-dwelling elderly women who had not had a prior hip fracture. We prospectively followed them to assess incident hip fracture. Prevalent radiographic vertebral deformities were identified at baseline using morphometry, and incident hip fractures were confirmed by review of radiographic reports during three follow-up periods (0-5, >5-10, and >10 years after baseline exam). RESULTS: Among women who survived for 10 or more years after the baseline exam without having had a hip fracture, a history of non-spine non-hip fracture since age 50 reported at the baseline study examination was associated with a 21% age- and calcaneal BMD-adjusted excess risk (hazard ratio [HR], 1.21; 95% CI, 1.01-1.45) for subsequent incident hip fracture. Baseline radiographic vertebral deformity was associated with a 41% age- and BMD-adjusted excess risk (HR, 1.41; 95% CI, 1.15-1.73) of hip fracture after 10 years of follow-up. In comparison, the age- and BMD-adjusted HRs of incident hip fracture during the first 5 years of follow-up associated with prior non-spine non-hip fractures reported at the baseline study exam and prevalent radiographic vertebral deformities were 1.70 (95% CI, 1.30-2.22) and 2.10 (95% CI, 1.58-2.78), respectively. CONCLUSIONS: Self-reported prior non-spine non-hip fractures and prevalent radiographic vertebral deformities known to be at least 10 years old are modestly associated with incident hip fracture. The association between these predictor fractures and subsequent hip fractures seems to wane with increased time after ascertainment of the predictor fracture. Hip fracture risk assessment strategies incorporating prior fracture history should also consider elapsed time since those prior fractures. 相似文献
6.
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
7.
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
8.
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
9.
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
10.
J. A. Langlois M. E. Mussolino M. Visser A. C. Looker T. Harris J. Madans 《Osteoporosis international》2001,12(9):763-768
Although weight loss increases bone loss and hip fracture risk in older women, little is known about the relation between
weight loss in middle-aged women and subsequent hip fracture risk. The objective of this study was to determine the association
between weight loss from reported maximum body weight in middle-aged and older women and the risk of hip fracture. Data were
from a nationally representative sample of 2180 community-dwelling white women aged 50–74 years from the Epidemiologic Follow-up
Study of the first National Health and Nutrition Examination Survey (NHEFS). In this prospective cohort study, incident hip
fracture was ascertained during 22 years of follow-up. The adjusted relative risks associated with weight loss of 10% or more
from maximum body weight were elevated for both middle-aged (RR 2.54; 95% CI 1.10–5.86) and older women (RR 2.04; 95% CI 1.37–3.04).
For both ages combined, women in the lowest tertile of body mass index at maximum who lost 10% or more of weight had the highest
risk of hip fracture (RR 2.37; 95% CI 1.32–4.27). Weight loss from maximum reported body weight in women aged 50–64 years
and 65–74 years increased their risk of hip fracture, especially among those who were relatively thin. Weight loss of 10%
or more from maximum weight among both middle-aged and older women is an important indicator of hip fracture risk.
Received: 13 August 1999 / Accepted: 26 April 2000 相似文献
11.
G. Leidig-Bruckner B. Limberg D. Felsenberg T. Bruckner S. Holder A. Kather J. Miksch C. Wüster R. Ziegler C. Scheidt-Nave 《Osteoporosis international》2000,11(2):102-119
Morphometric methods have been developed for standardized assessment of vertebral deformities in clinical and epidemiologic
studies of spinal osteoporosis. However, vertebral deformity may be caused by a variety of other conditions. To examine the
validity of morphometrically assessed vertebral deformities as an index of osteoporotic vertebral fractures, we developed
an algorithm for radiological differential classification (RDC) based on a combination of quantitative and qualitative assessment
of lateral spinal radiographs. Radiographs were obtained in a population of 50- to 80-year-old German women (n= 283) and men (n = 297) surveyed in the context of the European Vertebral Osteoporosis Study (EVOS). Morphometric methods (Eastell 3 SD and
4 SD criteria, McCloskey) were validated against RDC and against bone mineral density (BMD) at the femur and the lumbar spine.
According to RDC 36 persons (6.2%) had at least one osteoporotic vertebral fracture; among 516 (88.9%) nonosteoporotics 154
had severe spondylosis, 132 had other spinal disease and 219 had normal findings; 14 persons (2.4%) could not be unequivocally
classified. The prevalence of morphometrically assessed vertebral deformities ranged from 7.3% to 19.2% in women and from
3.5% to 16.6% in men, depending on the stringency of the morphometric criteria. The agreement between RDC and morphometric
methods was poor. In men, 62–86% of cases with vertebral deformities were classified as nonosteoporotic (severe spondylosis
or other spinal disease) by RDC, compared with 31–68% in women. Among these, most had wedge deformities of the thoracic spine.
On the other hand, up to 80% of osteoporotic vertebral fractures in men and up to 48% in women were missed by morphometry,
in particular endplate fractures at the lumbar spine. In the group with osteoporotic vertebral fractures by RDC the proportion
of persons with osteoporosis according to the WHO criteria (T-score <−2.5 SD) was 90.0% in women and 86.6% in men, compared with 67.9–85.0% in women and 20.8–50.0% in men with vertebral
deformities by various methods. Although vertebral deformities by most definitions were significantly and inversely related
to BMD as a continuous variable in both sexes [OR; 95% CI ranged between (1.70; 1.07–2.70) and (3.69; 1.33–10.25)], a much
stronger association existed between BMD and osteoporotic fractures defined by RDC [OR; 95% CI between (4.85; 2.30–10.24)
and (15.40; 4.65–51.02)]. In the nonosteoporotic group individuals with severe spondylosis had significantly higher BMD values
at the femoral neck (p <0.01) and lumbar spine (p <0.0004) compared with the normal group. On the basis of internal (RDC) and external (BMD) validation, we conclude that assessment
of vertebral osteoporotic fracture by quantitative methods alone will result in considerable misclassification, especially
in men. Criteria for differential diagnosis as used within RDC can be helpful for a standardized subclassification of vertebral
deformities in studies of spinal osteoporosis.
Received: 5 February 1999 / Accepted: 24 June 1999 相似文献
12.
J. D. Adachi G. Ioannidis C. Berger L. Joseph A. Papaioannou L. Pickard E. A. Papadimitropoulos W. Hopman S. Poliquin J. C. Prior D. A. Hanley W. P. Olszynski T. Anastassiades J. P. Brown T. Murray S. A. Jackson A. Tenenhouse 《Osteoporosis international》2001,12(11):903-908
Health-related quality of life (HRQL) was examined in relation to prevalent fractures in 4816 community-dwelling Canadian
men and women 50 years and older participating in the Canadian Multicentre Osteoporosis Study (CaMos). Fractures were of three
categories: clinically recognized main fractures, subclinical vertebral fractures and fractures at other sites. Main fractures
were divided and analyzed at the hip, spine, wrist/forearm, pelvis and rib sites. Baseline assessments of anthropometric data,
medical history, therapeutic drug use, spinal radiographs and prevalent fractures were obtained from all participants. The
SF-36 instrument was used as a tool to measure HRQL. A total of 652 (13.5%) main fractures were reported. Results indicated
that hip, spine, wrist/forearm, pelvis and rib fractures had occurred in 78 (1.6%), 40 (0.8%), 390 (8.1%), 19 (0.4%) and 125
(2.6%) individuals, respectively (subjects may have had more than one main fracture). Subjects who had experienced a main
prevalent fracture had lower HRQL scores compared with non-fractured participants. The largest differences were observed in
the physical functioning (−4.0; 95% confidence intervals (CI): −6.0, −2.0) and role-physical functioning domains (−5.8; 95%
CI: −9.5, −2.2). In women, the physical functioning domain was most influenced by hip (−14.9%; 95% CI: −20.9, −9.0) and pelvis
(−18.1; 95% CI: −27.6, −8.6) fractures. In men, the role-physical domain was most affected by hip fractures (−35.7; 95% CI:
−60.4, −11.1). Subjects who experienced subclinical vertebral fractures had lower HRQL scores than those without prevalent
fractures. In conclusion, HRQL was lower in the physical functioning domain in women and the role-physical domain in men who
sustained main fractures at the hip. Subclinical vertebral fractures exerted a moderate effect on HRQL.
Received: 1 November 2000 / Accepted: 23 March 2001 相似文献
13.
T. P. van Staa T. P. van Staa T. P. van Staa H. G. M. Leufkens C. Cooper 《Osteoporosis international》2002,13(8):624-629
The extent to which a fracture at one skeletal site predicts further fractures at other sites remains uncertain. We addressed
this issue using information from the UK General Practice Research Database, which contains the medical records of general
practitioners; our study population consisted of all patients aged 20 years or older with an incident fracture during 1988
to 1998. We identified 222 369 subjects (119 317 women, 103 052 men) who had sustained at least one fracture during follow-up.
There was a 2- to 3-fold increase in the risk of subsequent fractures at different skeletal sites. A patient with a radius/ulna
fracture had a standardized incidence ratio (SIR) of 3.0 (95% confidence interval 2.9–3.1) for fractures at a different skeletal
site; for initial vertebral fracture, this ratio was 2.9 (2.8–3.1) and for initial femur/hip fracture it was 2.6 (2.5–2.7).
The SIRs were generally higher among men than women. Men aged 65–74 years with a radius/ulna fracture or vertebral fracture
had substantially higher rates of subsequent femur/hip fractures than expected; SIRs were 6.0 (3.4–9.9) and 13.4 (7.3–22.5).
Corresponding SIRs among women of similar age were 3.3 (2.8–3.9) and 5.8 (4.1–8.1), respectively. Men and women aged 65 years
or older with a vertebral fracture had a 5-year risk of femur/hip fracture of 6.7% and 13.3%, respectively. Our results indicate
that fractures at any site are strong risk factors for subsequent fractures, among both elderly men and women.
Received: 19 November 2001 / Accepted: 13 February 2002 相似文献
14.
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
15.
Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. 总被引:17,自引:0,他引:17
D M Black N K Arden L Palermo J Pearson S R Cummings 《Journal of bone and mineral research》1999,14(5):821-828
Although vertebral deformities are known to predict future vertebral deformities, little is known about their ability to predict other osteoporotic fractures. We examined the association between prevalent vertebral deformities and incident osteoporotic fractures in the Study of Osteoporotic Fractures, a prospective study of 9704 women aged 65 years and older. Prevalent vertebral deformities were determined morphometrically from spinal radiographs at baseline and incident deformities from repeat spinal radiographs after a mean of 3.7 years. Appendicular fractures were collected by postcard every 4 months for a mean of 8.3 years. During follow-up, 389 women with new vertebral deformities, 464 with hip fractures, and 574 with wrist fractures were identified. Prevalent vertebral deformities were associated with a 5-fold increased risk (relative risk 5.4, 95% confidence interval [CI] 4.4, 6.6) of sustaining a further vertebral deformity; the risk increased dramatically with both the number and severity of the prevalent deformities. Similarly, the risks of hip and any nonvertebral fractures were increased with baseline prevalent deformity, with relative risks of 2.8 (95% CI 2.3, 3.4) and 1.9 (95% CI 1.7, 2.1), respectively. Risk increased with number and severity of deformities. These associations remained significant after adjustment for age and calcaneal bone mineral density (BMD). Although there was a small increased risk of wrist fracture, this was not significant after adjusting for age and BMD. In conclusion, the presence of prevalent morphometrically defined vertebral deformities predicts future vertebral and nonvertebral fractures, including hip but not wrist fractures. Spinal radiographs identifying prevalent vertebral deformities may be a useful additional measurement to classify further a woman's risk of future fracture. 相似文献
16.
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
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.
Predicting Fractures Using Bone Mineral Density: A Prospective Study of Long-Term Care Residents 总被引:9,自引:0,他引:9
K. E. Broe M. T. Hannan D. K. Kiely C. M. Cali L. A. Cupples D. P. Kiel 《Osteoporosis international》2000,11(9):765-771
Bone mineral density (BMD) has been shown to predict fracture risk in community-dwelling older persons; however, no comparable
prospective study has been performed in the long-term care setting where the role of BMD testing is uncertain. To determine
the ability of a single BMD measurement to predict the risk of subsequent fracture in long-term care residents, we designed
a prospective study in a 725-bed long-term care facility. A total of 252 Caucasian nursing home residents (mean age 88 years,
74% women) were recruited between 1992 and 1998. BMD of the hip, radius or both sites was measured using dual-energy X-ray
absorptiometry. Participants were followed through September 1999 for the occurrence of fracture. Cox proportional hazards
regression models were constructed to determine the relationship between BMD and the risk of fracture controlling for potentially
confounding variables. Sixty-three incident osteoporotic fractures occurred during a median follow-up time of 2.3 years. The
multivariate-adjusted risk of fracture for each standard deviation decrease in BMD was 2.82 (95% CI 1.81–4.42) at the total
hip, 2.79 (95% CI 1.69–4.61) at the femoral neck, 2.26 (95% CI 1.51–3.38) at the trochanter, 1.83 (95% CI 1.14–2.94) at the
radial shaft and 1.84 (95% CI 1.21–2.80) at the ultradistal radius. Subjects in the lowest age-specific quartile of femoral
neck BMD had over 4 times the incidence of fracture compared with those in the highest quartile. BMD at either hip or radius
was a predictor of osteoporotic fracture, although in women, radial BMD did not predict fracture. Knowledge of BMD in long-term
care residents provides important information on subsequent fracture risk.
Received: 3 December 1999 / Accepted: 17 March 2000 相似文献
19.
Digital X-ray radiogrammetry (DXR) is a technique that uses automated image analysis of standard hand radiographs to estimate
bone mineral density (DXR-BMD). Previous studies have shown that DXR-BMD measurements have high precision, are strongly correlated
with forearm BMD and are lower in individuals with prevalent fractures. To determine whether DXR-BMD measurements predict
wrist, hip and vertebral fracture risk we conducted a case–cohort study within a prospective study of 9704 community-dwelling
elderly women (the Study of Osteoporotic Fractures). We compared DXR-BMD, and BMD of the radius (proximal and distal), calcaneus,
femoral neck and posteroanterior lumbar spine in women who subsequently suffered a wrist (n= 192), hip (n= 195), or vertebral fracture (n= 193) with randomly selected controls from the same cohort (n= 392–398). DXR-BMD was estimated from hand radiographs acquired at the baseline visit. The radiographs were digitized and
the Pronosco X-posure System was used to compute DXR-BMD from the second through fourth metacarpals. Wrist fractures were
confirmed by radiographic reports and hip fractures were confirmed by radiographs. Vertebral fractures were defined using
morphometric analysis of lateral spine radiographs acquired at baseline and an average of 3.7 years later. Age-adjusted odds
ratio (OR, vertebral fracture) or relative hazard (RH, wrist and hip fracture) for a 1 SD decrease in BMD were computed. All
BMD measurements were similar for prediction of wrist (RH = 1.5–2.1) and vertebral fracture (OR = 1.8–2.5). Femoral neck BMD
best predicted hip fracture (RH = 3.0), while the relative hazards for all other BMD measurements were similar (RH = 1.5–1.9).
These prospective data indicate that DXR-BMD performs as well as other peripheral BMD measurements for prediction of wrist,
hip and vertebral fractures. Therefore, DXR-BMD may be useful for prediction of fracture risk in clinical settings where hip
BMD is not available.
Received: 27 April 2001 / Accepted: 10 October 2001 相似文献
20.
Quantitative ultrasound (QUS) is emerging as a simple, inexpensive and noninvasive method for assessing bone quality and
assessing fracture risk. We assessed the usefulness of a contact calcaneal ultrasonometer by studying normal premenopausal
women (group I, n= 53), normal postmenopausal women (group II, n= 198), and osteoporotic women without (group III, n= 141) and with vertebral fractures (group IV, n= 53). The osteoporotic subjects had a T-score of the spine or hip neck bone mineral density (BMD) <−2.5 based on the local Chinese peak young mean values. When compared
with postmenopausal controls, mean broadband ultrasound attenuation (BUA), speed of sound (SOS), and quantitative ultrasound
index (QUI) were 26%, 2.1% and 25% lower in women with vertebral fractures (p all <0.005). The correlation coefficients between QUS parameters and BMD of the spine and hip ranged between 0.4 and 0.5.
The ability of the QUS to discriminate between patients groups was determined based on the mean value of normal premenopausal
women in group I. The mean T-score for women with fractures was −2.87 ± 1.02 for BUA, −2.54 ± 0.79 for SOS, −3.17 ± 0.70 for QUI, −2.65 ± 0.86 for L2–4
BMD and −2.53 ± 0.66 for hip neck BMD. After adjustment for age and body mass index, the odds ratio of vertebral fracture
was 1.71 (95% CI 1.2–2.6) for each 1 SD reduction in BUA, 2.72 (1.3–5.3) for SOS, 2.58 (1.4–4.6) for QUI, 2.33 (1.6–3.3) for
L2–4 BMD, 2.09 (1.37–3.20) for femoral neck BMD and 1.88 (1.34–2.92) for total hip BMD. The association between the QUS parameters
and vertebral fracture risk persisted even adjustment for BMD. The area under the receiver operating characteristic curve
for BUA for vertebral fracture was 0.92, for SOS, QUI, L2–4 BMD and femoral neck BMD was 0.95, and for total hip was 0.91.
Received: 7 January 1999 / Accepted: 18 May 1999 相似文献