High-trauma fractures and low bone mineral density in older women and men
High-trauma fractures and low bone mineral density in older women and men
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DOI：
10.1001/jama.298.20.2381
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发表时间：
2007-11-28
影响因子：
120.7
通讯作者：
Cummings, Steven R.
中科院分区：
文献类型：
--
作者：
Mackey, Dawn C.;Lui, Li-Yung;Cummings, Steven R.
研究背景：人们普遍认为，高度创伤导致的骨折并不严重;目的探讨老年男性和女性骨密度（BMD）与高创伤性骨折以及高创伤性骨折与继发性骨折之间的关系。两项前瞻性美国队列研究，来自不同地理位置的65岁或以上的社区居民。骨质疏松性骨折研究对8022名妇女进行了9.1年的随访（1988-2006）。男性骨质疏松性骨折研究对5995名男性进行了为期5.1年的随访（2000-2007）。主要结果测量髋关节和脊柱BMD采用双能X线吸收法进行评估。影像学报告证实了非脊柱骨折事件。骨折被分类，没有知识的BMD，作为高创伤（由于机动车碰撞和福尔斯从大于站立的高度）或低创伤（由于福尔斯从站立的高度和不太严重的创伤）。对于女性，全髋BMD每减少1-SD，高创伤性骨折（多变量相对危险度[RH]，1.45; 95%置信区间[CI]，1.23-1.72）和低创伤性骨折（RH，1.49; 95% CI，1.42-1.57）的风险增加。男性的结果一致（高创伤骨折RH，1.54; 95%CI，1.20-1.96;低创伤骨折RH，1.69; 95%CI，1.49-1.91）。与没有高创伤骨折或低创伤骨折的女性相比，初始高创伤骨折的女性随后骨折的风险分别高34%（95% CI，7%-67%）和31%（95% CI，20%-43%）。后续骨折的风险没有modeled为maneuver.Conclusions低创伤非脊柱骨折，高创伤非脊柱骨折与低BMD和老年人后续骨折的风险增加。高创伤性非脊柱骨折应作为骨质疏松症试验和观察性研究的结局。
Context It is widely believed that fractures resulting from high trauma are not osteoporotic; however, this assumption has not been studied prospectively.Objective To examine the association between bone mineral density (BMD) and high-trauma fracture and between high-trauma fracture and subsequent fracture in older women and men.Design, Setting, and Participants Two prospective US cohort studies in community-dwelling adults 65 years or older from geographically diverse sites. The Study of Osteoporotic Fractures followed up 8022 women for 9.1 years (1988-2006). The Osteoporotic Fractures in Men Study followed up 5995 men for 5.1 years (2000-2007).Main Outcome Measures Hip and spine BMD were assessed by dual-energy x-ray absorptiometry. Incident nonspine fractures were confirmed by radiographic report. Fractures were classified, without knowledge of BMD, as high trauma (due to motor vehicle crashes and falls from greater than standing height) or as low trauma (due to falls from standing height and less severe trauma).Results Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3211 women and 346 men sustained an initial low-trauma fracture. For women, each 1-SD reduction in total hip BMD was similarly associated with an increased risk of high-trauma fracture (multivariate relative hazard [RH], 1.45; 95% confidence interval [CI], 1.23-1.72) and low-trauma fracture (RH, 1.49; 95% CI, 1.42-1.57). Results were consistent in men ( high-trauma fracture RH, 1.54; 95% CI, 1.20-1.96; low-trauma fracture RH, 1.69; 95% CI, 1.49-1.91). Risk of subsequent fracture was 34%( 95% Cl, 7%-67%) greater among women with an initial high-trauma fracture and 31%( 95% Cl, 20%-43%) greater among women with an initial low-trauma fracture, compared with women having no high- or low trauma fracture, respectively. Risk of subsequent fracture was not modeled for men.Conclusions Similar to low-trauma nonspine fractures, high- trauma nonspine fractures are associated with low BMD and increased risk of subsequent fracture in older adults. High-trauma nonspine fractures should be included as outcomes in osteoporosis trials and observational studies.