Genetic liability to fractures in the elderly
Genetic liability to fractures in the elderly
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DOI：
10.1001/archinte.165.16.1825
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发表时间：
2005-09-12
影响因子：
--
通讯作者：
Pedersen, NL
中科院分区：
文献类型：
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作者：
Michaëlsson, K;Melhus, H;Pedersen, NL
背景：基因对骨质疏松性骨折病因的影响尚不清楚。一项大型的双胞胎研究非常适合于确定不同年龄的骨折类别的遗传易感性。方法：使用1896-1944年出生的所有33432名瑞典双胞胎的队列来评估老年人发生骨折的遗传易感性。瑞典住院患者登记处和计算机辅助的电话访谈使我们能够识别出6021名患有任何骨折的双胞胎，3599名患有骨质疏松性骨折的双胞胎，以及1055名50岁后患有髋部骨折的双胞胎。结果：骨折易感性的遗传变异因骨折类型和年龄的不同而有很大差异。只有不到20%的总体年龄调整骨折变异是由遗传变异解释的。任何骨质疏松性骨折的年龄调整遗传率略高(0.27；95%可信区间[CI]，0.09-0.28)，仅髋部骨折的遗传度为0.48(95%CI，0.28-0.57)。在进一步调整已知的几个骨质疏松协变量后，遗传度并未减弱，但69岁前首次髋部骨折(0.68；95%CI，0.41~0.78)和69~79岁之间首次髋部骨折(0.47；95%CI，0.04~0.62)的遗传度显著高于79岁后首次髋部骨折(0.03~195%CI，0.00~0.26)。结论：遗传因素对骨折倾向的重要性取决于骨折部位和年龄。应该鼓励寻找易感基因和环境因素，这些基因和环境因素可能调节年轻老年髋部骨折患者的这些基因的表达，髋部骨折是最具破坏性的骨质疏松性骨折。预防高龄老年人骨折的重点应放在生活方式的干预上。
Background: The genetic impact on the causation of osteoporotic fractures is unclear. A large twin study is ideally suited to determine the genetic liability to categories of fracture at various ages.Methods: A cohort of all 33 432 Swedish twins born from 1896 to 1944 was used to evaluate the genetic liability to fracture occurrence in the elderly. The Swedish Inpatient Registry and computer-assisted telephone interviews enabled us to identify 6021 twins with any fracture, 3599 with an osteoporotic fracture, and 1055 with a hip fracture after the age of 50 years.Results: Genetic variation in liability to fracture differed considerably by type of fracture and age. Less than 20% of the overall age-adjusted fracture variance was explained by genetic variation. The age-adjusted heritability of any osteoporotic fracture was slightly greater (0.27; 95% confidence interval [CI], 0.09-0.28), and for hip fracture alone, it was 0.48 (95% CI, 0.28-0.57). Heritability was not attenuated after further adjustment for several known osteoporotic covariates but was considerably greater for first hip fractures before the age of 69 years (0.68; 95% CI, 0.41-0.78) and between 69 and 79 years (0.47; 95% CI, 0.04-0.62) than for hip fractures after 79 years of age (0.03-195% CI, 0.00-0.26).Conclusions: The importance of genetic factors in propensity to fractures depends on fracture site and age. The search for susceptibility genes and environmental factors that may modulate expression of these genes in younger elderly patients with hip fracture, the most devastating osteoporotic fracture, should be encouraged. Prevention of fractures in the oldest elderly should focus on lifestyle interventions.