新疆地区女性绝经后原发性骨质疏松患者 联合用药治疗的临床研究

目的通过完全随机化对照研究,探讨不同药物组合对女性绝经后原发性骨质疏松症患者的 治疗效果。方法选择我院2008年5月-2009年12月期间,绝经后的骨质疏松患者;共298人,年 龄50-87岁,平均（67. 3±10. 5 )岁。随机被分为3组,分别为：粤组：钙（Ca )垣骨化三醇组（C);B 组：钙（Ca)+骨化三醇（C )垣降钙素（CT)组;C组：钙（Ca)+骨化三醇（C )+双磷酸盐组（BP )。进 行药物治疗观察1年以上。观察药物治疗期间骨密度、骨生化指标25-( OH )D猿、BAP、TRACP-5h变化 情况,从药物疗效、依从性、恶性事件,骨折发生率等多方面加以研究。结果：最终完成研究的共有 220人（74. 5%)。A组治疗依从性要好于B组和C组（P <0.01 ),B组治疗依从性要差于C组尤其前 半年（P <0.05 )。B组,C组联合用药前后骨密度的改善最为明显,骨生化指标变化明显,差异有显著 性（P <0.05 )。显示A组对治疗骨质疏松症效果有限,B组治疗半年后患者BAP水平明显上升且 TRACP-5b）明显下降（P <0.05 ),一年后患者胸椎及髋部BMD分别提高了 7.08%,及9. 60豫。C组骨 生化变化趋势与B组类似,胸椎及髋部BMD分别提高了 5. 07%和6. 92%。B组,C组再骨折发生低 于A组。结论钙剂和维生素D基础用药的基础上联合抗骨吸收药物阿伦膦酸钠或降钙素早期较 明显抑制骨吸收,一年后可以明显提高骨密度,且降低新发骨折的发生率。它们联合治疗达到了叠加 的效果,1+1 >2。但联合治疗由于费用、不良反应的增加,降低了治疗依从性。此外新疆地区女 性绝经后原发性骨质疏松患者25-( OH)D3用药剂量不足,应更多补充维生素D。     

抗骨质疏松对老年性桡骨远端骨折的临床疗效

目的探讨抗骨质疏松对老年性骨质疏松性桡骨远端骨折的治疗效果。方法对84例老年原发骨质疏松性桡骨远端骨折患者先测定股骨颈骨密度值,随机分为治疗组（44例）及对照组（40例）,根据病情选用手法或手术复位。治疗组予肌注鲑鱼降钙素（密盖息）,口服阿仑膦酸钠片（固邦）、阿法骨化醇胶丸及钙尔奇D600片,对照组不予抗骨质疏松治疗,仅予安慰剂：肌注VitB1,口服VitC、VitE、VitAD胶丸。两组共使用药物10周,患者每15天行X线照片检查,观察骨折断端骨痂生长情况并进行疗效对比;治疗10周后再次测定股骨颈骨密度值并进行比较。结果治疗组治疗8周后与对照组比较,骨痂形成时间短,数量明显增加,骨皮质增厚,骨折愈合时间分别为：治疗组（6.8±1.5）周,对照组（8.5±2.5）周,差异有显著性（P〈0.05）;治疗组骨密度治疗前（0.618±0.092）g/cm^2,治疗后（0.643±0.088）g/cm^2,治疗前后差异有显著性（P〈0.05）;对照组治疗前BMD（0.620±0.085）g/cm^2,治疗后BMD（0.626±0.091）g/cm^2,治疗前后差异无显著性（P〉0.05）;两组治疗后比较差异有显著性（P〈0.05）。结论对老年性骨质疏松性桡骨远端骨折进行抗骨质疏松治疗,能促进骨痂提早形成,增加骨痂生成数量,增加骨密度,改善骨结构,提高骨的生物力学特性和抗骨折线力,增加骨折稳定性,减少外固定时间。     

阿法骨化醇联合唑来膦酸对骨质疏松症患者骨密度及OPG、BMP-2的影响

目的探讨阿法骨化醇联合唑来膦酸的治疗方案对骨质疏松患者骨密度及OPG、BMP-2的影响。方法将80例骨质疏松患者随机分成联合组和单一治疗组。两组患者均接受常规基础治疗,单一治疗组患者在此基础上接受唑来膦酸治疗,联合治疗组患者接受阿法骨化醇联合唑来膦酸的治疗方案。于治疗前及治疗12个月后评估两组患者的腰椎正位(L_(2-4))骨密度、股骨颈骨密度、骨保护蛋白(OPG)水平、骨形态发生蛋白-2(BMP-2)水平及治疗效果。结果治疗后,两组患者的腰椎正位(L_(2-4))骨密度、股骨颈骨密度、OPG及BMP-2均较治疗前有所改变(P0.01);联合治疗组患者的腰椎正位(L_(2-4))骨密度及股骨颈骨密度均高于单一治疗组患者(P0.01);联合治疗组患者的OPG水平高于单一治疗组患者(P0.01);联合治疗组患者的BMP-2水平高于单一治疗组患者(P0.01);联合治疗组患者的总有效率(97.5%)高单一治疗组患者(82.5%)(P0.01)。结论阿法骨化醇联合唑来膦酸在骨质疏松患者中的效果较好,可明显提高患者的骨密度,提高OPG水平,提升BMP-2水平,促进患者的恢复。     

唑来膦酸治疗老年女性骨质疏松性骨折的研究

目的 研究唑来膦酸治疗老年女性骨质疏松性骨折的疗效。方法 选择2009年至2010年住院的60岁以上女性长骨骨折患者192例检测BMD,分为治疗组和对照组,两组均在治疗骨折同时给予钙剂和骨化三醇治疗,治疗组于术后1-2周给予唑来膦酸5mg静脉滴注。术后每12个月复查并记录腰椎部骨密度变化,同时观察术后骨折愈合情况、3年内再骨折率的差异。结果 在治疗三年后治疗组骨密度较对照组均有所提高,且差异有统计学意义（p<0.05）;术后三年内治疗组再骨折率低于对照组,且差异有统计学意义（p<0.05）;在骨折愈合方面两组随访3月骨折均愈合良好,结果差异无统计学意义（p>0.05）。结论 唑来膦酸可以有效降低老年女性骨质疏松性骨折患者的再骨折率、提高骨密度,且并不影响骨折愈合。     

老年骨质疏松症股骨颈骨折术后抗骨质疏松治疗的初步观察

目的探讨老年人骨质疏松症股骨颈骨折术后应用（密盖息＋钙＋维生素D3）方案抗骨质疏松治疗的效果。方法随机选择诊断为“原发性骨质疏松症＋股骨颈病理性骨折”的老年患者56例,人工关节置换术后除髋关节康复锻炼外,应用（密盖息＋钙＋维生素D3）方案治疗3个月,比较治疗前后临床症状和空腹血钙、磷、甲状旁腺激素、碱性磷酸酶、24h尿钙、磷以及定量CT腰椎骨密度值变化。结果周身疼痛症状改善有效率为50％;治疗3个月前、后空腹血钙、磷、甲状旁腺激素、碱性磷酸酶、24h尿钙、磷变化间的差异无统计学意义（P〉0．05）;腰椎骨密度值间的差异有统计学意义（P〈0．01）。结论老年人股骨颈骨折术后应用（密盖息＋钙＋维生素D3）方案抗骨质疏松治疗能有效增加骨密度,改善疼痛,从而预防再次骨折。     

唑来膦酸联合骨水泥技术治疗老年骨质疏松性骨折的疗效分析

目的探讨唑来膦酸(密固达)联合骨水泥技术治疗老年骨质疏松性骨折的临床疗效。方法回顾性分析我科于2010~2011年收治老年骨质疏松性骨折并行PVP/PKP骨水泥技术治疗的病人,20例获得随访,依据PVP/PKP术后是否应用唑来膦酸治疗,分成对照组及实验组。所有病人分别于治疗前和治疗后1年进行股骨近端骨密度测量及疼痛VAS临床评分,评价治疗效果。结果治疗1年后实验组患者股骨近端骨密度明显提高,脊柱骨疼痛症状较对照组得到持续缓解,治疗后1年内无新发骨折。对照组1年期间有脊柱骨性疼痛加重趋势,1例患者术后2月后再次出现新发椎体骨质疏松性骨折。唑来膦酸用药后主要临床不良反应为类流感样反应,包括发热、面红、周身不适等,短期内可缓解,患者均可耐受。结论唑来膦酸联合骨水泥技术治疗老年骨质疏松性骨折效果显著,可明显提高骨质疏松性患者骨密度,预防骨量持续丢失,提高患者生活质量,并有效减轻全身及胸腰部骨性疼痛症状,预防再次骨折发生。应用唑来膦酸给药方便、依从性较好,不良反应轻微、可达到全身系统化治疗,可作为骨质疏松性骨折PVP术后一种良好的辅助治疗措施。     

PKP联合不同抗骨质疏松药物治疗骨质疏松性脊柱压缩骨折的临床疗效比较

目的观察PKP术后联合不同抗骨质疏松药物治疗骨质疏松性脊柱压缩骨折的临床疗效。方法 112例骨质疏松性脊柱压缩骨折患者行PKP术,根据联合应用不同抗骨质疏松药物分为3(A、B、C)组,对比术前及术后3、6、9个月各组VAS评分、骨密度、再发椎体骨折情况。结果 3组术前及术后3个月VAS评分、骨密度无统计学差异,各组均未出现相邻椎体骨折;术后6个月A组VAS评分与B组和C组有统计学差异(P0.05),骨密度无统计差异(P0.05),A组第6个月时出现2例椎体骨折,B组、C组未发生;术后9个月A组VAS评分、骨密度与B、C组均有统计差异,B组与C组VAS评分无差异,但骨密度有统计学差异,B组第9个月出现1例椎体骨折,其它组未出现。结论 PKP联合应用抗骨质疏松药物可显著降低骨质疏松性脊柱骨折术后的腰背部疼痛及相邻椎体再骨折,增加骨质强度,在临床上不同时期可选择合理药物治疗。     

抗骨质疏松配合人工股骨头置换术治疗高龄髋部骨折的临床研究

目的：观察高龄人工股骨头置换患者术后抗骨质疏松治疗的效果,以提高人工髋关节治疗水平。方法将46例高龄人工股骨头置换术术后患者分为抗骨质疏松治疗组和对照组,两组均每日常规口服钙尔奇D600 mg、骨化三醇0.25μg,抗骨质疏松治疗组进行包括健康宣教、生活习惯调整、抗骨质疏松药物、物理治疗、康复运动治疗及家庭康复指导等的综合治疗,并测量患者术前、术后骨密度、VAS评分及Harris评分。结果46例人工股骨头置换患者治疗效果良好：（1）术后6个月、12个月抗骨质疏松治疗组骨密度、Harris评分均较对照组高,在统计学上有差异（P＜0.05）;（2）术后3 d,术后6个月、12个月抗骨质疏松治疗组VAS评分均较对照组低,在统计学上有差异（ P＜0.05）。结论综合抗骨质疏松治疗有利于提高高龄人工股骨头置换患者骨密度和生活质量。     

降钙素联合骨化三醇胶丸对糖尿病合并骨质疏松症的影响

目的探讨降钙素联合骨化三醇胶丸治疗糖尿病合并骨质疏松症患者对骨代谢、骨密度及血糖的影响。方法采用配对比较法将我院2011年1月至2015年12月收治的2型糖尿病合并骨质疏松症患者分为接受骨化三醇胶丸治疗的对照组及接受降钙素联合骨化三醇胶丸治疗的观察组,各40例。两组均接受基础降糖治疗,观察两组患者治疗前及治疗1年后骨代谢、血糖、骨密度情况和治疗期间的不良反应。骨代谢指标包括骨钙素(bone gamma-carboxyglutamic-acid-containing proteins,BGP)、β-胶原片段(beta-crosslaps,β-CTX)、25羟基维生素D[25-hydroxyvitamin D,25(OH)D]、人骨碱性磷酸酶(bone alkaline phosphatase,BALP)、甲状旁腺素(parathyroid hormone,PTH)。结果两组治疗前骨代谢指标、血糖指标及不同部位骨密度对比,差异无统计学意义(P0.05),观察组治疗1年后BGP、β-CTX、BALP、PTH低于同组治疗前及对照组同期(P0.05),25(OH)D及不同部位骨密度均高于同组治疗前及对照组同期(P0.05),空腹及餐后2 h血糖低于治疗前(P0.05),但与对照组相当(P0.05);观察组总有效率(97.50%)高于对照组(80.00%)(P0.05);两组不良反应发生率对比,差异无统计学意义(P0.05)。结论降钙素联合骨化三醇对糖尿病合并骨质疏松患者疗效显著,可有效改善骨代谢,治疗骨质疏松。     

老年女性桡骨远端骨折与骨密度的相关性及药物治疗的临床效果

目的 研究老年女性桡骨远端骨折与其骨密度(BMD)的相关性及骨折后不同抗骨质疏松治疗方案的临床效果,为老年患者桡骨远端骨折的防治提供理论依据.方法 自2004年1月到2006年1月,共收集老年妇女桡骨远端骨折117例,平均年龄67.5岁,随机分成两组,A组在进行常规桡骨远端骨折治疗同时应用钙剂+阿法迪三;B组在进行常规桡骨远端骨折治疗同时应用钙剂+阿法迪三+降钙素,药物治疗疗程1年.106名未骨折的老年妇女为对照组.所有患者均进行了随访,应用DEXA分别对健侧桡骨远端、腰椎和髋部的BMD进行检测;摄X线片以了解骨折愈合情况及全身其他部位再次发生与骨质疏松相关的骨折情况.将所得数据进行统计学分析.结果 在所有发生桡骨远端骨折的老年妇女中83%的患者腰椎和髋部的BMD低,89%的患者健侧桡骨远端的BMD低,能诊断骨质疏松者为59%,均较对照组降低,差别有显著性(P<0.05);而A、B组之间BMD无显著性差异.在骨折后一年,A组患者腰椎、髋部和健侧桡骨远端的BMD有不同程度的降低,而B组患者腰椎、髋部和对侧桡骨远端的BMD有不同程度的升高,两组之间的差别有显著性(P<0.05);A、B组骨折临床愈合时间比较差别无显著性(P＞0.05).首次骨折2年内 A组患者其他部位再次发生与骨质疏松相关的骨折6例,再骨折率10.2%;B组患者再骨折2例,再骨折率3.5%.结论 老年妇女桡骨远端骨折的发生与腰椎、髋部的BMD 的降低明显相关,特别是健侧桡骨远端的BMD;在进行骨折治疗中,在应用钙剂加阿法迪三基础治疗的同时应用降钙素可能更好地降低再骨折的发生.     

福善美预防绝经后胸腰椎压缩性骨折再骨折25例疗效观察

目的 探讨福善美治疗绝经后妇女腰椎骨折及预防骨折再发生的临床疗效。方法45例绝经后骨质疏松伴腰椎压缩骨折患者随机分组,分别服用福善美及单纯钙剂,进行疗效对照研究,用药1年比较治疗前后骨密度及再骨折率。结果 用福善美治疗1年后,腰椎骨密度及股骨颈骨密度分别增加(5.0±2.5)％,(1.8±2.2)％。单纯钙剂分别为:(0 2±3.8)％,(-1.0±4.0)％,差异有显著性(P<0.01)。治疗组再骨折率为4％(1:25),对照组为27％(5:19)(P相似文献   

FRAX软件评估北京地区中老年人骨折风险的预测价值

目的评估不同部位骨密度(bone mineral density,BMD)值代入FRAX工具后对于北京地区中老年人骨折风险的预测价值。方法收集北京地区9 726例中老年人群的相关资料,应用FRAX~?中国模式分别代入髋部BMD及腰椎BMD时10年内主要部位骨质疏松性骨折及髋部骨折的概率,评估FRAX~?在中老年人骨折风险的预测价值。结果 (1)应用FRAX~?分别代入髋部BMD及腰椎BMD后计算10年内主要部位骨质疏松性骨折及髋部骨折概率并行配对样本秩和检验,差异均具有统计学意义(P0.05)。(2)代入髋部BMD后,男性及女性人群随年龄增大,10年内主要部位骨质疏松性骨折及髋部骨折概率均增加。代入腰椎BMD后,女性人群随着年龄增大,10年内主要部位骨质疏松性骨折及髋部骨折概率均增加,但男性人群上述骨折概率并不伴随着年龄增大而增加。(3)总人群中合并既往骨折史的骨折风险高于无既往骨折史人群。结论髋部BMD及腰椎BMD代入FRAX后均能较好地预测未来10年骨折的风险概率;对于男性病例,应用FRAX时更推荐代入髋部BMD预测未来10年骨折的风险概率;FRAX~?对中老年人骨折风险预测具有重要价值。     

骨密度在髋部骨质疏松性骨折风险评估中的价值

目的评估骨密度在髋部脆性骨折风险预测中的临床价值。方法回顾性研究2014年6月至2019年6月在我院创伤骨科住院的老年髋部骨折患者72例,作为病例组,其中股骨转子间骨折31例,股骨颈骨折41例;对照组选择同期我院骨外科门诊老年体检者63例。使用DXA方法测量患者腰椎和健侧髋部(全髋部、转子间、股骨颈、Ward’s区)的骨密度;对照组测量腰椎和左侧髋部骨密度,统计分析测量结果。结果①骨折组腰椎、髋部骨密度均显著低于对照组,差异有统计学意义(P0.01);②转子间骨折组和股骨颈骨折组在腰椎和髋部区域骨密度比较差异均无统计学意义(P 0.05);③骨折组与对照组在转子间区的T值降低比例最大为122.1%,腰椎降低幅度最小为31.3%,余髋部的T值均有不同程度降低;④骨折后髋部和腰椎T值比存在倒置现象;⑤对照组和骨折组髋部骨质疏松程度比较,差异有统计学意义(P0.01);两组患者腰椎骨质疏松程度比较,差异无统计学意义(P0.05)。结论①髋部骨折患者骨密度均显著低于体检者,提示骨密度与髋部骨折具有一定相关性,但与髋部骨折类型无关;②在髋部骨折风险评估中,髋部骨密度相比腰椎更有价值;③当髋部与腰椎T值比出现倒置时,将不可避免发生髋部骨折;④骨量正常的部分患者发生了脆性骨折,而骨质疏松的部分患者却未发生骨折,表明影响骨折发生的因素除了骨密度外,可能和骨骼的微结构有关。     

骨质疏松骨折后再骨折的临床风险因素

 目的 探讨骨质疏松患者初次骨折后发生再骨折的风险及其临床特点。方法 收集2006年1月至2008年1月门诊及住院的年龄50岁以上、临床可确诊的骨质疏松骨折患者273例,根据是否有骨质疏松骨折病史分为再骨折组48例和骨折组225例。分析患者一般资料、骨折类型、股骨颈DXA骨密度测定T值、Charlson合并症指数、骨折时间等临床特征,并行运动协调技能评价。结果骨折组年龄（67.7±8.5）岁,再骨折组（72.7±9.5）岁;再骨折组女性占77.1%,高于骨折组女性构成比70.2%;再骨折类型以椎体骨折后再次发生股骨颈骨折最多见,其次为股骨颈骨折后再次发生股骨颈骨折。再骨折发生的风险因素包括高龄（>75岁,HR =1.23;>85岁,HR =1.68）、女性（HR=1.36）、曾发生椎体骨折（HR=1.62）、曾发生髋部骨折（HR=1.27）,骨密度- T值<-3.5（HR =1.38）及运动协调技能减退（HR= 1.27）。再骨折平均发生于初次骨折后(3.7±2.5)年。骨折组随访2年内再骨折发生率4.9%(11/225)。结论 有初次骨质疏松骨折病史的患者发生再骨折的风险仍然很明显,两次骨折之间有足够的间隔采取措施降低再骨折的风险。特别是对发生椎体、髋部骨折的老年女性应进行干预,进行运动协调技能的康复训练和防跌倒练习。     

The distal radial fracture in elderly women and the bone mineral density of the lumbar spine and hip

The incidence of distal radial fractures in elderly women is high and is associated with osteoporosis and hip fracture. Osteoporosis can be detected by measuring the bone mineral density (BMD) of the lumbar spine or hip with dual energy X-ray absorptiometry. Low BMD of the lumbar spine or hip is a strong predictor for future vertebral deformities and hip fractures. At present, elderly women with a distal radial fracture are not investigated for osteoporosis on a routine basis. The BMD of the lumbar spine and hip were assessed in 94 women (mean age, 69 years) with a distal radial fracture. A low BMD was found in 85% of the patients, and osteoporosis was diagnosed in 51%. The mean BMD decreased by 0.04 SD per year and there was a significant relationship between post-menopausal status and decreased BMD of the hip. The BMD in patients treated with bisphosphonate medication increased significantly in 1 year. As more than half of the elderly women with a distal radial fracture have osteoporotic BMD values for the lumbar spine or hip, it is our opinion that such patients should be screened for osteoporosis.     

Differences in Site-Specific Fracture Risk Among Older Women with Discordant Results for Osteoporosis at Hip and Spine: Study of Osteoporotic Fractures

To examine the fracture pattern in older women whose bone mineral density (BMD) T-score criteria for osteoporosis at hip and spine disagree, hip and spine BMD were measured in Study of Osteoporotic Fractures participants using dual energy X-ray absorptiometry (DXA). Hip osteoporosis was defined as T-score ≤−2.5 at femoral neck or total hip, and spine osteoporosis as T-score ≤−2.5 at lumbar spine. Incident clinical fractures were self-reported and centrally adjudicated. Incident radiographic spine fractures were defined morphometrically. Compared to women with osteoporosis at neither hip nor spine, those osteoporotic only at hip had a 3.0-fold age- and weight-adjusted increased risk for hip fracture (95% confidence interval [CI]: 2.4–3.6), and smaller increases in risk of nonhip nonspine (hazard ratios [HR] = 1.6), clinical spine (odds ratio [OR] = 2.2), and radiographic spine fractures (OR = 1.5). Women osteoporotic only at spine had a 2.8-fold increased odds of radiographic spine fracture (95% CI: 2.1–3.8), and smaller increases in risk of clinical spine (OR = 1.4), nonhip nonspine (HR = 1.6), and hip fractures (HR = 1.2). Discordant BMD results predict different fracture patterns. DXA fracture risk estimation in these patients should be site specific. Women osteoporotic only at spine would not have been identified from hip BMD measurement alone, and may have a sufficiently high fracture risk to warrant preventive treatment.     

Number of osteoporotic sites and fracture risk assessment: a cohort study from the Manitoba Bone Density Program.

Site-discordance in BMD assessment is common and significantly affects patient categorization. Greater number of osteoporotic sites correlates with lower T scores at each index site. This largely explains the positive association between number of osteoporotic sites and fracture risk. INTRODUCTION: Site-discordance in BMD is common when used to classify patients based on a cut-off T score of -2.5. It is unclear whether fracture risk assessment is improved by considering BMD information from multiple sites. Our objective was to assess the contribution of number of osteoporotic sites to overall fracture risk. MATERIALS AND METHODS: The study population was drawn from the regionally based clinical database of the Manitoba Bone Density Program that includes all clinical DXA test results for the Province of Manitoba, Canada. Analyses were limited to 16,505 women>or=50 years of age at the time of baseline DXA of the spine (L1-L4) and hip (three sites). During follow-up (3.2+/-1.5 years), longitudinal health service records showed 765 women with at least one osteoporotic fracture code (hip, forearm, spine, or humerus). RESULTS: Of 5012 women classified as osteoporotic by at least one site (T score -2.5 or lower), almost one half (2370; 47%) were abnormal at only a single site. Among the 1856 women with an osteoporotic total hip measurement, mean total hip T scores decreased as the number of additional osteoporotic sites increased (-2.58, no other osteoporotic sites; -2.69, one other site; -2.87, two other sites; -3.17, three other sites; Spearman r=-0.44, p<0.0001). Age-adjusted fracture risk from a Cox proportional hazards model increased as the number of osteoporotic sites increased (p<0.0001), but number of osteoporotic sites was no longer an independent predictor after total hip BMD was included as a covariate (p=0.19). Covariate adjustment for other sites of BMD measurement attenuated, but did not eliminate, the effect of number of osteoporotic sites. CONCLUSIONS: Site-discordance is common and significantly affects patient categorization when different skeletal sites are used for diagnosis. Greater number of osteoporotic sites correlates with lower T scores at each index site. This largely explains the positive association between number of osteoporotic sites and fracture risk.     

Association between self-reported prior wrist fractures and risk of subsequent hip and radiographic vertebral fractures in older women: a prospective study.

In this large prospective cohort study of elderly women, the relationships between prior wrist fracture and incident hip and radiographic vertebral fractures were significantly attenuated when adjusted for BMD. This study suggests that BMD thresholds for drug therapy to prevent osteoporotic fracture should be only modestly adjusted in those with prior wrist fracture compared with those without prior wrist fracture. Validation of such an approach would require intervention trials in patients with prior wrist fracture. INTRODUCTION: Prior wrist fracture has been identified as a risk factor for incident hip and vertebral fractures and proposed as a criterion for determining who should be offered drug therapy to prevent osteoporotic fracture, even if their hip BMD T score is > -2.5. Previously published studies of the relationships between prior wrist fracture and incident hip and vertebral fractures did not adjust for BMD. MATERIALS AND METHODS: We ascertained prior history of wrist fracture since age 50, measured calcaneal and hip BMD, and performed lateral spine films in a cohort of 9704 elderly community-dwelling women, and then followed them prospectively for incident vertebral and hip fractures. Incident vertebral fractures were defined by morphometry using lateral spine radiography at the first examination and an average of 3.7 years later. Incident hip fractures were confirmed with radiographic reports over a mean follow-up period of 10.1 years. RESULTS: Prior wrist fracture was associated with an age-adjusted 72% increased odds of incident radiographic vertebral fracture (odds ratio [OR], 1.72; 95% CI, 1.31-2.25). After adjustment for calcaneal BMD, the association of prior wrist fracture with incident radiographic vertebral fracture was attenuated (OR, 1.39; 95% CI, 1.05-1.83). Prior wrist fracture was also associated with an age-adjusted 43% excess rate of incident hip fracture (hazards ratio [HR], 1.43; 95% CI, 1.17-1.74). After adjustment for hip BMD, the association of prior wrist fracture with rate of incident hip fracture was no longer statistically significant (HR, 1.12; 95% CI, 0.92-1.38). CONCLUSION: In elderly women, prior wrist fracture is a risk factor for radiographic vertebral fracture independent of BMD. The association between prior wrist fracture and incident hip fracture is largely explained by hip BMD. Modest adjustment of BMD drug treatment thresholds for prevention of osteoporotic fractures in those with prior wrist fracture compared with those without prior wrist fracture may be reasonable, but validation of such an approach would require intervention trials in patients with prior wrist fracture.     

Bone mineral density 6 years after a hip fracture: a prospective, longitudinal study

The purpose of this prospective study was to extend the results of previous studies to determine if an accelerated rate of loss of bone mineral density (BMD) continues for 6 years after a hip fracture. Eighty-five elderly patients who had sustained a hip fracture had determinations of BMD made at the time of fracture; 55 of these patients were available for reassessment of BMD 1 year later, and 21 were available for reassessment of BMD 6 to 7 years later. The change in BMD from injury to 1 year and from 1 to 6 years was determined and correlated with pre- and postinjury variables, such as ambulatory ability, dietary intake of calcium, serum vitamin D levels, and mental status. There was a marked decrease in BMD in the in the first year after fracture, with the mean change in BMD being -4.3% at the femoral neck and -1.8% at the lumbar spine. Between 1 and 6 years after fracture, however, there was a dramatic increase in the BMD at both the femoral neck and lumbar spine measurement sites. Relative to 1 year after fracture, the mean increases were 7.7% at the femoral neck and 4.5% at the lumbar spine. In many cases, the loss of bone mineral that occurred in the first year after fracture was completely recouped in the subsequent 5 years. Five of the 21 patients (24%) sustained a contralateral hip fracture in the 6 years after the index fracture. Lumbar spine BMD was lower at baseline (p = 0.112), 1 year after fracture (p = 0.007), and 6 years after fracture (p = 0.003) in patients who sustained a second hip fracture than in those who did not. There was a general decrease in the functional activity level of patients in the 6 years after a hip fracture, but there were no statistically significant relationships between changes in BMD and the functional mobility of patients. The mean calcium intake in patients improved remarkably in the 6 years after fracture, but there was no correlation between daily calcium intake and changes in BMD. During the first year after a hip fracture, there is a rapid loss of bone mineral from the lumbar spine and contralateral femoral neck. Between 1 and 6 years after fracture, however, BMD is likely to increase, perhaps to levels greater than those at baseline. Although this investigation is small, the findings of this study point to the importance of further larger studies to further clarify the natural history of BMD after a hip fracture and the potential impact of pharmacological intervention on that natural history.     

Epidemiology of osteoporosis in Okinawa

International comparisons of fracture incidence of the femoral neck, bone mineral density of the axial and appendicular bones, calcium intake and daily activities in aged populations are extremely important for identifying preventive measures to be taken against senile osteoporosis. We surveyed the femoral neck fracture rate for four years from 1986 to 1989 in Okinawa Prefecture, and investigated bone mineral density of the lumbar spine and proximal femur by dual photon absortiometry or dual energy quantitative computed tomography in both normal subjects and osteoporotics with spinal compression fractures or hip fractures. Information on past and current daily activities and calcium intakes were collected through interviews or questionnaires on some of these control or osteoporotic subjects. The incidence of hip fracture in Okinawa was relatively higher than that in other prefectures of Japan, but apparently lower than that in Caucasian populations. In normal subjects, the slope of the overall regression line for bone mass vs age in women was 2.2 times steeper than that in men at the lumbar spine, but it was almost identical at the proximal femur in both sexes. Middle aged women lost BMD at both skeltal sites almost 2 times faster than that of overall women. BMD values of the osteoporotics with fractures were significantly lower than those of control subjects before 70 years. The high calcium intake group (more than 600mg/day) showed significantly higher BMD values at both skeltal sites comapred to the low calcium group (less than 600mg/day). Past daily activity level was significantly correlated with BMD values of each skeltal site, but current daily activity level correlated only with BMD for the lumbar spine.