After the initial fracture in postmenopausal women, where do subsequent fractures occur?
After the initial fracture in postmenopausal women, where do subsequent fractures occur?
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DOI：
10.1016/j.eclinm.2021.100826
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发表时间：
2021-05
影响因子：
15.1
通讯作者：
Cauley JA
中科院分区：
文献类型：
--
作者：
Crandall CJ;Hunt RP;LaCroix AZ;Robbins JA;Wactawski-Wende J;Johnson KC;Sattari M;Stone KL;Weitlauf JC;Gure TR;Cauley JA
绝经后妇女初次骨折后后续骨折的位置尚不清楚。我们对女性健康倡议（1993-2018）参与者初次骨折后的后续骨折进行了前瞻性分析，这些参与者提供了随访（平均 15.4 年，SD 6.2 年）数据（n = 157,282 名参与者；基线年龄 50-79 岁；47,458 名发生骨折的参与者）。 Cox 比例风险模型针对年龄、种族/民族、体重指数和其他协变量进行了调整。每种类型的初始骨折后，每种类型的后续骨折的风险都会增加。发生下臂/手腕骨折与上臂/肩部、大腿、膝盖、小腿/脚踝、髋部/骨盆和脊柱后续骨折的风险显着升高相关（调整后的风险比[aHR]范围为2·63-5·68）。初次发生下臂或腕部骨折（aHR 4·80，95% CI 4·29–5·36）、初次上臂或肩部骨折（aHR 5·06，95% CI 4·39–5·82）、初次大腿骨折（aHR 5·11，95% CI 3·91–6·67）、初次膝部骨折（aHR 5·03， 95% CI 4·20–6·03)，初始小腿/踝关节骨折(aHR 4·10，95% CI 3·58–4·68)，初始脊柱骨折(aHR 6·69，95% CI 5·95–7·53)。相关性在所有年龄组中均显着，甚至在 50-59 岁的女性中也是如此。非西班牙裔黑人、西班牙裔/拉丁裔和亚裔/太平洋岛民中随后发生骨折的风险比非西班牙裔白人女性更为明显。所有年龄段的所有骨折类型均观察到后续骨折的风险增加。经历过任何这些骨折的女性都应该接受干预措施，以防止随后发生骨折。美国国立卫生研究院 HHSN268201600018C、HHSN268201600001C、HHSN268201600002C、HHSN268201600003C 和 HHSN268201600004C。
The locations of subsequent fractures after initial fracture in postmenopausal women are poorly characterized. We conducted a prospective analysis of subsequent fractures after initial fracture in Women's Health Initiative (1993–2018) participants who provided follow-up (mean 15.4 years, SD 6.2 years) data (n = 157,282 participants; baseline age 50–79; 47,458 participants with incident fracture). Cox proportional hazards models were adjusted for age, race/ethnicity, body mass index, and other covariates. The risk of each type of subsequent fracture was increased after each type of initial fracture. Incident lower arm/wrist fracture was associated with significantly elevated risks of subsequent fractures at the upper arm/shoulder, upper leg, knee, lower leg/ankle, hip/pelvis, and spine (adjusted hazard ratios [aHRs] ranging 2·63–5·68). The risk of hip fracture was increased after initial lower arm or wrist fracture (aHR 4·80, 95% CI 4·29–5·36), initial upper arm or shoulder fracture (aHR 5·06, 95% CI 4·39–5·82), initial upper leg fracture (aHR 5·11, 95% CI 3·91–6·67), initial knee fracture (aHR 5·03, 95% CI 4·20–6·03), initial lower leg/ankle fracture (aHR 4·10, 95% CI 3·58–4·68), and initial spine fracture (aHR 6·69, 95% CI 5·95–7·53). Associations were significant in all age groups, even women aged 50–59 years. Risks of subsequent fracture were more pronounced among non-Hispanic Black, Hispanic/Latina, and Asian/Pacific Islander than among non-Hispanic White women. Increased risk of subsequent fracture is observed for all fracture types across all ages. Women who experience any of these fractures should be targeted for interventions to prevent subsequent fractures. National Institutes of Health HHSN268201600018C,HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.
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