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1.
Body mass index (BMI) has been found to be related to the risk of osteoporotic hip fractures in women, regardless of bone
mineral density (BMD). The same relationship is under debate for other limb fragility fractures. Very few studies have investigated
the comparison of fracture risk among BMI categories, classified according to the WHO criteria, despite the potential usefulness
of such information for clinical purposes. To address these issues we studied 2,235 postmenopausal women including those with
fragility fractures of the hip (187), ankle (108), wrist (226) and humerus (85). Statistical analyses were performed by logistic
regression by treating the fracture status as the dependent variable and age, age at menopause, femoral neck BMD and BMI as
covariates. BMI was tested as a continuous or categorical variable. As a continuous variable, increased BMI had a protective
effect against hip fracture: OR 0.949 (95% CI, 0.900–0.999), but carried a higher risk of humerus fracture: OR 1.077 (95%
CI, 1.017–1.141). Among the BMI categories, only leanness: OR 3.819 (95% CI, 2.035–7.168) and obesity: OR 3.481 (95% CI, 1.815–6.678)
showed a significantly higher fracture risk for hip and humerus fractures, respectively. There was no relationship between
ankle and wrist fractures and BMI. In conclusion, decreasing BMI increases the risk for hip fracture, whereas increasing BMI
increases the risk for humerus fractures. Leanness-related low BMD and obesity-related body instability might explain the
different BMI relationships with these two types of fracture. 相似文献
2.
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
3.
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
4.
N. Boonyaratavej P. Suriyawongpaisal A. Takkinsatien S. Wanvarie R. Rajatanavin P. Apiyasawat 《Osteoporosis international》2001,12(3):244-248
Hip fractures are among the most important causes of ill health and death among elderly people. Several potentially modifiable
risk factors have been reported. Most claimed physical activity as a promising, inexpensive preventive measure for hip fracture.
However, knowledge about risk factors for hip fracture in Asian populations is very limited. We therefore conducted a case–control
study to assess the relationships between physical activity and risk of hip fractures in Thai women. From 14 hospitals in
Thailand, 229 cases with a radiologically confirmed first hip fracture were enrolled. Two hundred and twenty-four controls
were randomly recruited from the same neighborhood and were matched to the cases by age within a 5 year range. Information
on physical activity as well as other potential confounders was obtained through personal interviews. Multivariate logistic
regression revealed that past physical activity was protective in both very active and active women (OR = 0.67, 95% CI = 0.40–1.12
for moderately active women and OR = 0.20, 95% CI = 0.10–0.38 for very active women; p value for trend <0.01). Recent physical activity reduced the risk to about two-thirds (OR = 0.33, 95% CI = 0.19–0.60 and
OR = 0.35, 95% CI = 0.18–0.69 for moderately and very active women respectively). In addition, breastfeeding was identified
to be a protective factor (OR = 0.87, 95% CI = 0.80–0.94). In contrast, the following risk factors were identified: current
use of antihistamine (OR = 13.96, 95% CI = 1.38–141.13) or traditional medicine (OR = 7.66, 95% CI = 2.71–21.63), underlying
cerebrovascular diseases (OR = 6.53, 95% CI = 2.10–20.34), history of fracture (OR = 4.04, 95% CI = 1.26–12.99), parental
Chinese racial background (OR = 2.52, 95% CI = 1.49–4.23), alcohol consumption (OR = 2.30, 95% CI = 1.04–5.09).
Received: 14 April 2000 / Accepted: 17 October 2000 相似文献
5.
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
6.
Few studies have examined risk factors for fractures of the wrist, shoulder or ankle. The Blue Mountains Eye Study is a population-based
longitudinal study in 3654 people aged 49 years or older resident in an area west of Sydney, Australia. Detailed eye examinations
and interviews were carried out at baseline (1992–3) and after 5 years (1997–9). Information about fractures sustained during
follow-up were collected by a combination of self-report and a search of hospital radiology records. After 4.7 years follow-up
subjects had sustained 53 fractures of the distal forearm, 20 fractures of the proximal humerus and 33 ankle fractures. In
multivariate models factors independently associated with wrist fractures in women were no vigorous exercise in the past 2
weeks (relative risk RR 0.4, 95% CI 0.2–0.9) and ever use of HRT (RR 0.4, 95% CI 0.1–1.0). Factors independently associated
with ankle fractures were male sex (RR 0.3, 95% CI 0.1–0.8) and visual field loss (RR 2.8, 95% CI 1.2–6.6). These findings
are in keeping with other studies, and suggest that different types of osteoporotic fracture have different, if overlapping,
sets of risk factors.
Received: 28 December 2000 / Accepted: 21 June 2001 相似文献
7.
M. Palvanen P. Kannus J. Parkkari T. Pitkäja¨rvi M. Pasanen I. Vuori M. Järvinen 《Osteoporosis international》2000,11(10):822-831
The risk factors for falls in older adults are well known but knowledge on the direct injury mechanisms that result in various
osteoporotic fractures has been very sparse. The purpose of this study was therefore to clarify the injury mechanisms of osteoporotic
upper extremity fractures of older adults and to compare these mechanisms with those of the control fallers, and in this way
to obtain reliable insight into the etiology and pathogenesis of upper extremity fractures and thus to enable fracture prevention.
One hundred and twelve patients with a fresh fracture of the proximal humerus, 65 patients with an elbow fracture, 110 patients
with a wrist fracture and 108 controls (no fracture, or a fracture other than the case fracture) were interviewed and examined
between September 1995 and December 1997. The inclusion criteria of the subjects were that the patient was 50 years of age
or older at the time of the accident, and that the fracture/injury had occurred as a result of low-energy trauma (typically
a fall from standing height or less) within a week before the interview and examination. In 97% of patients with a proximal
humerus or elbow fracture, and in all patients (100%) with a wrist fracture, the fracture was a result of a fall. In the control
group this figure was 93%. In a polychotomous logistic regression analysis the intergroup differences in the fall directions
(adjusted by gender, age and functional capacity) were statistically highly significant (χ2= 43.6, d.f. = 15, p<0.001). Most of the patients with a proximal humerus fracture or elbow fracture reported that they had fallen “obliquely
forward” (43% and 38%) or “to the side” (29% and 26%), whereas in the wrist fracture group the main fall direction was also
“obliquely forward” (34%) but the other fall directions (i.e., “forward”, “to the side”, “obliquely backward” and “backward”)
were quite equally represented (13–19%). The odds ratio (OR) for an obliquely forward fall resulting in a proximal humerus
fracture was 3.5 [95% confidence interval (CI) 1.4–9.2), as compared with the fall directions of the controls and the “obliquely
backward” fall direction. In a logistic regression analysis the patients with a wrist fracture managed to break their fall
(e.g., with an outstretched arm) more frequently than the patients in the other groups (OR 3.9; 95% CI 2.0–7.3). The patients
with a proximal humerus fracture, in turn, managed to break their fall less frequently than the controls (OR 0.33; 95% CI
0.14–0.80). The same was true of the patients with an elbow fracture, although the difference was not significant (OR 0.49%;
95% CI 0.19–1.3). As objective evidence for a direct fall-induced impact on the fracture site, 68% of patients with a proximal
humerus fracture revealed a fresh subcutaneous hematoma on the shoulder/upper arm, while such a hematoma was rare in the controls
(2%) (p<0.001). Correspondingly, 62% of patients with an elbow fracture showed a similar hematoma on the elbow area, while this was
seen in none of the controls (p<0.001). In patients with a wrist fracture a hand/wrist hematoma was seen in 58% of the victims, as compared with 18% of the
controls (p<0.001). The study shows that the most typical osteoporotic upper extremity fractures of older adults have their specific
injury mechanisms. A great majority of these fractures occur as a result of a fall and a subsequent direct impact of the fractured
site. Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced
impact force with injury site protection.
Received: 13 January 2000 / Accepted: 11 April 2000 相似文献
8.
L. J. Melton III R. D. Brown Jr S. J. Achenbach W. M. O’Fallon J. P. Whisnant J. P. Whisnant 《Osteoporosis international》2001,12(11):980-986
The overall risk of fracture following stroke has not been well quantified. We addressed this issue in a population-based
retrospective cohort study among the 387 Rochester, Minnesota residents who survived for 90 days following their first cerebral
infarction during the 10-year period, 1960–69. Cases were matched by age and sex to controls from the general population of
Rochester, and subsequent fractures were assessed through review of each subject’s complete (inpatient and outpatient) medical
records in the community. With comparable follow-up, the 128 fractures observed among cases were little more than the 118
seen among controls, and the cumulative incidence of any fracture after 25 years was not significantly different (71% versus
66%; p=0.464). Using stratified Cox analysis, there was no increase in the risk of fractures generally (hazard ratio (HR), 1.1;
95% CI, 0.8–1.6) or hip fractures specifically (HR, 1.1; 95% CI, 0.6–2.1) compared with controls. Among the stroke patients
with hemiparesis or hemiplegia, the majority of fractures occurred on the impaired side. In a multivariate analysis, fracture
risk increased with age (HR per 10 years, 1.6; 95% CI, 1.4–2.0), with hospitalization at onset of stroke (HR, 2.0; 95% CI,
1.3–3.2) and with moderate functional impairment (HR, 1.6; 95% CI, 1.02–2.5) but not severe disability (HR, 0.8; 95% CI, 0.4–1.6).
No other characteristic of the stroke or its treatment was an independent predictor of overall fracture risk. Patients and
their caretakers need to be aware of the risk of fracture from falls, particularly when moderate impairment permits the patient
to be independently mobile.
Received: 29 September 2000 / Accepted: 26 April 2001 相似文献
9.
Risk-taking,coordination and upper limb fractures in children: a population based case-control study
The aim of this population based case-control study was to examine the association between risk-taking behaviour, motor coordination and upper limb fractures in children aged 9–16 years. A total of 321 fracture cases and 321 randomly selected individually matched controls were studied. The number for different types of upper limb fractures was 91 for hand, 190 for wrist and forearm and 40 for upper arm. Risk-taking behaviour was determined by a 5-item interview-administered questionnaire. Motor coordination was assessed by the 8-point movement ABC that tests manual dexterity, ball skills as well as static and dynamic balance. Bone mass was assessed by dual energy X-ray absorptiometry (DXA) and metacarpal morphometry. In general, there was heterogeneity by fracture site with regard to associations. Risk-taking behaviour was associated with hand fracture risk but not other fracture sites for downhill cycling behaviour (OR: 2.0/category, 95% CI: 1.1–3.7), dare behaviour (OR: 3.3/category, 95% CI: 1.1–10.0) and total risk-taking score (OR: 2.6/category, 95% CI: 1.3–5.7). Conversely, coordination measures were associated with wrist and forearm fractures only: cutting/threading (OR: 1.2/unit, 95% CI: 1.0–1.4); flower trail (OR: 1.2/unit, 95% CI: 1.0–1.4) and dynamic balance score (OR: 1.1/unit, 95% CI: 1.0–1.2). Backward stepwise analysis selected total risk taking score for hand fracture, and dynamic balance score for wrist and forearm fracture. None of the risk-taking or coordination scores were associated with upper arm fractures. These associations were unchanged following adjustment for bone mass. In conclusion, the propensity to take risks is most strongly associated with hand fracture risk while dynamic balance is most strongly associated with wrist and forearm fracture risk in children. These results inform the development of fracture prevention strategies in children. 相似文献
10.
R. Honkanen M. Tuppurainen H. Kroger E. Alhava E. Puntila 《Calcified tissue international》1997,60(4):327-331
In a retrospective population-based study we assessed whether and how self-reported former fractures sustained at the ages
of 20–34 are associated with subsequent fractures sustained at the ages of 35–57. The 12,162 women who responded to fracture
questions of the baseline postal enquiry (in 1989) of the Kuopio Osteoporosis Study, Finland formed the study population.
They reported 589 former and 2092 subsequent fractures. The hazard ratio (HR), with 95% confidence interval (CI), of a subsequent
fracture was 1.9 (1.6–2.3) in women with the history of a former fracture compared with women without such a history. A former
low-energy wrist fracture was related to subsequent low-energy wrist [HR = 3.7 (2.0–6.8)] and high-energy nonwrist [HR = 2.4
(1.3–4.4)] fractures, whereas former high-energy nonwrist fractures were related only to subsequent high-energy nonwrist [HR
= 2.8 (1.9–4.1)] but not to low-energy wrist [HR = 0.7 (0.3–1.8)] fractures. The analysis of bone mineral density (BMD) data
of a subsample of premenopausal women who underwent dual x-ray absorptiometry (DXA) during 1989–91 revealed that those with
a wrist fracture due to a fall on the same level at the age of 20–34 recorded 6.5% lower spinal (P= 0.140) and 10.5% lower femoral (P= 0.026) BMD than nonfractured women, whereas the corresponding differences for women with a former nonwrist fracture due
to high-energy trauma were −1.8% (P= 0.721) and −2.4% (P= 0.616), respectively.
Our results suggest that an early premenopausal, low-energy wrist fracture is an indicator of low peak BMD which predisposes
to subsequent fractures in general, whereas early high-energy fractures are mainly indicators of other and more specific extraskeletal
factors which mainly predispose to same types of subsequent fractures only.
Received: 21 February 1996 / Accepted: 24 September 1996 相似文献
11.
Jaqueline B. Lopes Camille P. Figueiredo Valeria F. Caparbo Liliam Takayama Paulo R. Menezes Marcia Scazufca Rosa M.R. Pereira 《Journal of clinical densitometry》2011,14(3):359-366
The risk of osteoporotic fractures is known to vary among populations. There are no studies analyzing concomitantly clinical, densitometric, and lab risk factors in miscigenated community-dwelling population of Brazil. A total of 1007 elderly subjects (600 women and 407 men) from São Paulo, were evaluated using a questionnaire that included risk factors for osteoporotic fractures. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at the hip and lumbar spine. Laboratory blood tests were also obtained. The prevalence of osteoporotic fractures was 13.2% (133 subjects), and the main fracture sites were distal forearm (6.0%), humerus (2.3%), femur (1.3%), and ribs (1.1%). Women had a higher prevalence (17.5%; 95% confidence interval [CI]: 14.6–20.6) than men (6.9%; 95% CI: 4.4–9.3) (p < 0.001). After adjusting for significant variables, logistic regression revealed that female gender (odds ratio [OR] = 2.7; 95% CI; 1.6–4.5; p < 0.001), current smoking (OR = 1.9; 95% CI: 1.2–3.3; p = 0.013), and the femoral neck T-score (OR = 0.7; 95% CI: 0.5–0.9; p = 0.001) remain significant risk factors for osteoporotic fractures in the community-dwelling elderly. Our findings identified that female gender, current smoking, and low hip BMD are independent risk factors for osteoporotic fractures. 相似文献
12.
Lithium has been shown to inhibit bone resorption and to interact with Wnt signaling, potentially pointing to bone anabolic
properties. We, therefore, studied the effects of lithium on fracture risk using a case–control study design. Cases were all
subjects including children with any fracture sustained during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched according to age and gender was randomly drawn from the background population. Adjustments were made for
use of other psychotropic drugs (neuroleptics, antidepressants, and anxiolytics/sedatives), psychiatric disease (manic depressive
states, schizophrenia, and other psychoses), and other confounders. The effect of dose was examined by stratifying for cumulated
dose (DDD, defined daily dose). In the crude analysis, there was a decreasing relative risk of any fracture with increasing
accumulated dose of lithium. After adjustment for psychotropic drug use, the risk of any fracture was decreased (odds ratio
[OR] 0.74, 95% confidence interval [CI] 0.60–0.92 for 250–849 DDD, and OR 0.67, 95% CI 0.55–0.81 for ≥ 850 DDD of lithium).
For Colles’ fractures and spine fractures, a significant decrease was seen with ≥ 850 DDD (OR 0.57, 95% CI 0.35–0.94 for Colles’
fracture and OR 0.32, 95% CI 0.11–0.95 for spine fractures). For hip fractures, a nonsignificant trend toward a decrease was
seen; however, without a dose-response relationship. Adjustment for further confounders did not change the results. Lithium
treatment was associated with a decreased risk of fractures potentially pointing at bone anabolic properties. 相似文献
13.
We studied the effect of proton pump inhibitors, histamine H2 receptor antagonists, and other types of antacid drugs on fracture risk. All cases were subjects with any fracture sustained
during the year 2000 (n = 124,655). For each case, three controls (n = 373,962) matched on age and gender were randomly drawn from the background population. The primary exposure variables were
use of proton pump inhibitors, histamine H2 antagonists, and other antacid drugs. Adjustments were made for several confounders, including diagnosis of an ulcer, nonsteroidal
anti-inflammatory drug use, use of histamine H1 antagonists, stomach resection, previous fracture, and use of corticosteroids. The effect of dose was examined by stratifying
for cumulated dose (defined daily dose). Use of proton pump inhibitors was associated with an increase in fracture risk for
use within the last year [odds ratio (OR) = 1.18, 95% confidence interval (CI) 1.12–1.43 for overall fracture risk; OR = 1.45,
95% CI 1.28–1.65 for hip fractures; and OR = 1.60, 95% CI 1.25–2.04 for spine fractures). Histamine H2 antagonists were associated with a decreased fracture risk if they had been used within the last year (OR = 0.88, 95% CI
0.82–0.95 for any fracture, OR = 0.69, 95% CI 0.57–0.84 for hip fractures). Other antacids were not associated with overall
fracture risk but were associated with hip and spine fractures. Proton pump inhibitors appeared to be associated with a limited
increase in fracture risk, in contrast to histamine H
2
antagonists, which seemed to be associated with a small decrease in fracture risk. In all cases, the changes in risk estimates
were small and the clinical significance was limited. 相似文献
14.
A. C. Scane R. M. Francis A. M. Sutcliffe M. J. D. Francis D. J. Rawlings C. L. Chapple 《Osteoporosis international》1999,9(1):91-97
To investigate the pathogenesis and sequelae of symptomatic vertebral fractures (VF) in men, we have performed a case–control
study, comparing 91 men with VF (median age 64 years, range 27–79 years) with 91 age-matched control subjects. Medical history,
clinical examination and investigations were performed in all patients and control subjects, to identify potential causes
of secondary osteoporosis, together with bone mineral density (BMD) measurements. BMD was lower at the lumbar spine and all
sites in the hip in patients with VF than in control subjects (p<0.001). Potential underlying causes of secondary osteoporosis were found in 41% of men with VF, compared with 9% of control
subjects (OR 7.1; 95% CI 3.1–16.4). Oral corticosteroid and anticonvulsant treatment were both associated with a significantly
increased risk of VF (OR 6.1; 95% CI 1.3–28.4). Although hypogonadism was not associated with an increased risk of fracture,
the level of sex hormone binding globulin was higher (p<0.001) and the free androgen index lower (p<0.001) in men with VF than control subjects. Other factors associated with a significantly increased risk of VF were family
history of bone disease (OR 6.1; 95% CI 1.3–28.4), current smoking (OR 2.8; 95% CI 1.2–6.7) and alcohol consumption of more
than 250 g/week (OR 3.8; 95% CI 1.7–8.7). Men with VF were more likely to complain of back pain (p<0.001) and greater loss of height (p<0.001) than control subjects, and had poorer (p<0.001) scores for the energy, pain, emotion, sleep and physical mobility domains of the Nottingham Health Profile. We conclude
that symptomatic VF in men are associated with reduced BMD, underlying causes of secondary osteoporosis such as corticosteroid
and anticonvulsant treatment, family history of bone disease, current smoking and high alcohol consumption, and that they
impair the perceived health of the individual.
Received: 23 February 1998 / Accepted: 13 May 1998 相似文献
15.
M. Varenna MD L. Binelli F. Zucchi P. Beltrametti M. Gallazzi L. Sinigaglia 《Osteoporosis international》1997,7(6):558-563
To evaluate whether metatarsal fracture in postmenopausal women can be related to osteoporosis, a sample of 113 postmenopausal
women with metatarsal fracture due to minor trauma were recruited. Demographic and clinical data were compared with a control
group of 339 healthy age-matched women and with a sample of 224 women with wrist fracture. In all women, bone mineral density
(BMD) was measured at the lumbar spine by dual-energy X-ray absorptiometry. The average age of the metatarsal fracture group
was slightly lower than that of the wrist fracture group (56.9 vs 58.4 years). Women with metatarsal and wrist fracture had
a significantly higher age at menarche, lower age at menopause and lower body mass index when compared with controls. In both
fracture groups BMD was significantly lower compared with controls. In stepwise logistic regression models, factors associated
with metatarsal fracture risk were age at menopause (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.81–0.92) and BMD
(OR per — 1 SD 2.44; CI 1.92–3.11). Factors associated with wrist fracture risk included age at menopause (OR 0.89; CI 0.84–0.93)
and BMD (OR per — 1 SD 2.65; CI 2.17–3.24). The similarities existing in risk factors and their estimates between a well-recognized
osteoporotic fracture such as wrist fracture and metatarsal fracture, support the hypothesis that the latter can be included
among osteoporotic fractures. 相似文献
16.
W. D. Hosmer W. D. Hosmer H. K. Genant W. S. Browner W. S. Browner 《Osteoporosis international》2002,13(4):337-341
There is substantial interest in the early identification of women at risk for osteoporotic fractures, so that preventive
measures may be instituted early. We examined whether women with a history of fractures before menopause were at an increased
risk of fractures after menopause. We obtained information about any lifetime fractures of the hip, arm, spine, wrist, leg,
ankle, foot and finger from 9086 ambulatory white women ages 65 years and older participating in the Study of Osteoporotic
Fractures. We also measured bone mineral density and recorded history of falls, maternal fracture history, drug use, diet,
functional status, and other characteristics commonly associated with osteoporotic fractures. We used proportional hazards
models to estimate the effects of fractures that occurred before menopause on the risk of fractures after menopause, in particular
those that occurred during the 12 years of study follow-up. The risk of fractures of all types during the study period was
greater among women with a premenopausal fracture of any type compared with women without a premenopausal fracture (hazard
ratio (HR), 1.33; 95% confidence interval (CI), 1.14–1.56; p<0.001). Adjustment for possible confounders, including bone mineral density, had only a modest effect (HR, 1.25; 95% CI,
1.03–1.50; p<0.02). An increased risk of fracture among women with a premenopausal fracture was also seen after stratification by estrogen
use, propensity to fall and maternal fracture history. Premenopausal fractures are therefore a risk factor for subsequent
fractures independent of other risk factors for osteoporotic fractures, such as bone mineral density. A fracture history,
including fractures before menopause, should be obtained when making decisions about preventive treatments.
Received: 17 April 2000 / Accepted: 14 June 2000 相似文献
17.
Stephen H. Gray Catherine C. Vick Laura A. Graham Kelly R. Finan Leigh A. Neumayer Mary T. Hawn 《Journal of gastrointestinal surgery》2008,12(4):675-681
Objective This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes.
Methods Procedures were identified from the Veterans’ Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical
records and operative reports were physician abstracted to obtain preoperative and intraoperative variables.
Results Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%,
p < 0.0001), concomitant bowel resection (8.7% vs. 0.8%, p < 0.0001), return to operating room (7.9% vs. 2.5%, p = 0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p = 0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant
predictors of complications were emergent case (OR 5.4; 95% CI 3.1–9.4), diabetes (OR 2.1; 95% CI 1.2–3.8), congestive heart
failure (OR 4.0; 95% CI 1.4–11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1–3.6). Among emergent repairs,
cirrhosis (OR 4.4; 95% CI 1.3–14.3) was strongly associated with postoperative complications.
Conclusion Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics
is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis. 相似文献
18.
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
19.
Alexander A. Fisher Michael W. Davis Wichat Srikusalanukul Marc M. Budge 《Archives of osteoporosis》2006,1(1-2):13-19
Introduction The objectives were: (1) to estimate the prevalence of dementia in older people with hip fracture (HF) and (2) to evaluate
the significance of dementia and residential care as risk factors for HF in the Australian Capital Territory (ACT), Australia.
Methods We performed a prospective study of 555 consecutive patients (≥60 years) with HF (mean age 82.6±7.9 (SD) years; 74.2% women)
within 162,608 person-years of observation. The main predictor variables of HF were, pre-fracture diagnosed dementia of any
type and residential status. ACT population estimates and age- and gender-specific prevalence rates of dementia in the ACT
population were used to calculate the relative risk of HF in demented people.
Results Of those with HF, 176 (31.7%) were diagnosed with dementia prior to the fracture. Multiple logistic regression analysis revealed
that dementia in HF patients was associated with history of stroke (OR=2.2; 95% CI 1.2–4.0; p=0.008), residential care (OR=6.7; 95% CI 4.5–10.2; p=0.001) and older age (OR=1.03; 95% CI 1.0–1.1; p=0.036). The overall relative risk (RR) for HF in persons with dementia was 6.3 (95% CI 5.1–7.1) times higher than in those
without pre-fracture dementia, and the RR in the young-old (60–79 years) with dementia was higher than in the old-old (≥85
years). The RR of HF for demented persons living in long-term residential care facilities compared to the non-demented age-matched
community-dwelling population was 16.3 (95% CI 14.4–18.2; p=0.001).
Conclusions This study demonstrated a high prevalence of demented people among HF patients and a 6.3-fold risk for HF in older persons
with dementia. This risk is almost 2.6 times greater in demented people living in residential care. These data may be useful
in health policy decisions and strongly support development of targeted HF prevention strategies, planning and allocation
of resources and prioritisation of prevention efforts toward those with dementia, especially in residential care. 相似文献
20.
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