PREDICTING VERTEBRAL FRACTURE INCIDENCE FROM PREVALENT FRACTURES AND BONE-DENSITY AMONG NON-BLACK, OSTEOPOROTIC WOMEN
PREDICTING VERTEBRAL FRACTURE INCIDENCE FROM PREVALENT FRACTURES AND BONE-DENSITY AMONG NON-BLACK, OSTEOPOROTIC WOMEN
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DOI：
10.1007/bf01623272
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发表时间：
1993-05-01
影响因子：
4
通讯作者：
WASNICH, RD
中科院分区：
文献类型：
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作者：
ROSS, PD;GENANT, HK;WASNICH, RD
在一组绝经后骨质疏松症妇女中，我们评估了基线时的骨密度和椎体骨折预测椎体骨折发生率的能力。研究人群是380名绝经后妇女(平均年龄65岁)，他们在美国的七个地理中心进行了双磷酸盐的随机、安慰剂对照临床试验，接受骨质疏松症治疗。骨密度的基线测量是在1986年通过脊柱的定量计算机断层扫描和腰椎和髋部的双光子吸收测量法获得的。脊椎骨折在系列脊柱X线片上被记录下来。比例风险模型被用来评估在平均2.9年的随访期内预测后续骨折风险的能力。存在一个或两个骨折使新的椎体骨折发生率增加7.4倍(95%可信区间=1.0至55.9)。基线上的额外骨折进一步增加了骨折的发生率。骨密度仪测定的脊柱骨密度标准差每减少2个标准差，骨折发生率增加5.8倍(95%可信区间=2.9至11.6)。骨密度最低和最高的五分位数的绝对骨折发生率分别为每1000人年120例和6例。一般来说，同时使用两个预测指标(骨密度和普遍骨折或两个骨密度测量)与使用单一预测指标相比，可以改善骨折预测。我们得出结论，骨密度和普遍存在的椎体骨折都是椎体骨折风险的强有力的、互补的预测因子。结果表明，医生可以单独或联合使用骨密度和常见的椎体骨折作为危险因素，以确定新骨折风险最大的患者。
We evaluated the ability of bone density and vertebral fractures at baseline to predict vertebral fracture incidence in a cohort of postmenopausal women with osteoporosis. The study population was 380 postmenopausal women (mean age 65 years) treated for osteoporosis in a randomized, placebo-controlled, clinical trial of the bisphosphonate etidronate at seven geographic centers in the United States. Baseline measurements of bone mineral density were obtained in 1986 by quantitative computed tomography at the spine and dual-photon absorptiometry at the lumbar spine and hip. Vertebral fractures were documented on serial spine radiographs. Proportional hazards models were used to evaluate the ability to predict the risk of subsequent fractures during an average of 2.9 years of follow-up. Presence of one or two fractures increased the rate of new vertebral fractures 7.4-fold (95% confidence interval = 1.0 to 55.9). Additional fractures at baseline further increased the fracture rate. A decrease of 2 standard deviations in spinal bone density by absorptiometry was associated with a 5.8-fold increase in fracture rate (95% confidence interval = 2.9 to 11.6). The lowest and highest quintiles of bone density had absolute fracture rates of 120 and 6 cases per 1000 patient-years, respectively. In general, the simultaneous use of two predictors (bone density and prevalent fractures or two bone density measurements) improved fracture prediction, compared with the use of a single predictor. We conclude that both bone density and prevalent vertebral fractures are strong, complementary predictors of vertebral fracture risk. The results suggest that physicians can use bone density and prevalent vertebral fractures, individually or in combination, as risk factors to identify patients at greatest risk of new fractures.