FRAX underestimates fracture risk in patients with diabetes
FRAX underestimates fracture risk in patients with diabetes
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DOI：
10.1002/jbmr.556
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发表时间：
2012-02-01
影响因子：
6.2
通讯作者：
Kanis, John A.
中科院分区：
文献类型：
--
作者：
Giangregorio, Lora M.;Leslie, William D.;Kanis, John A.
本研究的目的是确定糖尿病是否是独立于WHO骨折风险评估工具（FRAX）的髋关节或主要腰椎骨折的危险因素。在加拿大马尼托巴的一个大型临床数据库中，确定了在骨矿物质密度（BMD）检测时（1990年至2007年）年龄≥ 50岁的男性和女性糖尿病患者（n =3518）和非糖尿病患者（n=36,085）。计算FRAX概率，并通过与基于人群的数据库的链接建立到2008年的骨折结局。多变量考克斯比例风险模型用于确定糖尿病是否与FRAX风险因素控制后发生髋部骨折或严重股骨骨折相关。两组间严重骨折（糖尿病组11.1 ± 7.2 vs非糖尿病组10.9 ± 7.3，p=0.116）和髋部骨折（糖尿病组2.9 ± 4.4 vs非糖尿病组2.8 ± 4.4，p=0.400）的平均10年骨折概率相似。在控制了年龄、性别、药物使用和FRAX风险因素（包括BMD）后，糖尿病是随后发生严重腰椎骨折的重要预测因素（风险比[HR]=1.61，95%置信区间[CI] 1.421.83）。直接调整FRAX概率后观察到类似结果（HR=1.59，95% CI 1.40 - 1.79）。糖尿病也与髋部骨折的高风险相关（p
The study objective was to determine whether diabetes is a risk factor for incident hip or major osteoporotic fractures independent of the WHO fracture risk assessment tool (FRAX). Men and women with diabetes (n=3518) and nondiabetics (n=36,085) aged =50 years at the time of bone mineral density (BMD) testing (1990 to 2007) were identified in a large clinical database from Manitoba, Canada. FRAX probabilities were calculated, and fracture outcomes to 2008 were established via linkage with a population-based data repository. Multivariable Cox proportional hazards models were used to determine if diabetes was associated with incident hip fractures or major osteoporotic fractures after controlling for FRAX risk factors. Mean 10-year probabilities of fracture were similar between groups for major fractures (diabetic 11.1 +/- 7.2 versus nondiabetic 10.9 +/- 7.3, p=0.116) and hip fractures (diabetic 2.9 +/- 4.4 versus nondiabetic 2.8 +/- 4.4, p=0.400). Diabetes was a significant predictor of subsequent major osteoporotic fracture (hazard ratio [HR]=1.61, 95% confidence interval [CI] 1.421.83) after controlling for age, sex, medication use, and FRAX risk factors including BMD. Similar results were seen after adjusting for FRAX probability directly (HR=1.59, 95% CI 1.401.79). Diabetes was also associated with significantly higher risk for hip fractures (p