Previous fractures at multiple sites increase the risk for subsequent fractures: the Global Longitudinal Study of Osteoporosis in Women.
Previous fractures at multiple sites increase the risk for subsequent fractures: the Global Longitudinal Study of Osteoporosis in Women.
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DOI：
10.1002/jbmr.1476
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
Lindsay R
中科院分区：
文献类型：
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作者：
Gehlbach S;Saag KG;Adachi JD;Hooven FH;Flahive J;Boonen S;Chapurlat RD;Compston JE;Cooper C;Díez-Perez A;Greenspan SL;LaCroix AZ;Netelenbos JC;Pfeilschifter J;Rossini M;Roux C;Sambrook PN;Silverman S;Siris ES;Watts NB;Lindsay R
以前的髋部、脊柱或手腕骨折是公认的未来骨折的预测指标，但其他骨折部位的作用不太清楚。我们试图评估10个骨骼位置的既往骨折与意外骨折之间的关系。全球女性骨质疏松症纵向研究(GLOW)是一项观察性队列研究，在10个国家的17个医生诊所进行。55岁的女性≥在基线、1年和/或2年(前一年发生骨折)时回答了问卷调查。在参与调查的60,393名女性中，有51,762人获得了后续数据。在这些人中，17.6%、4.0%和1.6%的人在45岁后遭受过1、2或≥3级骨折。在头两年的随访中，3149名女性遭受了3683次骨折。与以前没有骨折的女性相比，有1、2或≥3级骨折的女性发生任何意外骨折的可能性分别是1.8%、3.0%和4.8%；那些有≥3级骨折史的女性发生新椎体骨折的可能性是前者的9.1%。之前的10个骨折位置中有9个与意外骨折有关。发生脊柱和髋部骨折的最强预测因子是既往脊柱骨折(风险比7.3)和髋部(风险比3.5)。既往肋骨骨折与后续脊椎骨折的风险是2.3倍，先前的大腿骨折预测髋部骨折的风险是2.2倍；有脚踝骨折病史的女性未来负重骨骼骨折的风险是1.8倍。我们的发现表明，广泛的既往骨折部位与发生骨折的风险增加有关，这对临床评估和风险模型的开发具有重要意义。
Previous fractures of the hip, spine, or wrist are well-recognized predictors of future fracture, but the role of other fracture sites is less clear. We sought to assess the relationship between prior fracture at 10 skeletal locations and incident fracture. The Global Longitudinal Study of Osteoporosis in Women (GLOW) is an observational cohort study being conducted in 17 physician practices in 10 countries. Women ≥ 55 years answered questionnaires at baseline and at 1 and/or 2 years (fractures in previous year). Of 60,393 women enrolled, follow-up data were available for 51,762. Of these, 17.6%, 4.0%, and 1.6% had suffered 1, 2, or ≥3 fractures since age 45. During the first 2 years of follow-up, 3149 women suffered 3683 incident fractures. Compared with women with no prior fractures, women with 1, 2, or ≥ 3 prior fractures were 1.8-, 3.0-, and 4.8-fold more likely to have any incident fracture; those with ≥3 prior fractures were 9.1-fold more likely to sustain a new vertebral fracture. Nine of 10 prior fracture locations were associated with an incident fracture. The strongest predictors of incident spine and hip fractures were prior spine fracture (hazard ratio 7.3) and hip (hazard ratio 3.5). Prior rib fractures were associated with a 2.3-fold risk of subsequent vertebral fracture, previous upper leg fracture predicted a 2.2-fold increased risk of hip fracture; women with a history of ankle fracture were at 1.8-fold risk of future fracture of a weight-bearing bone. Our findings suggest that a broad range of prior fracture sites are associated with an increased risk of incident fractures, with important implications for clinical assessments and risk model development.