Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study
Fracture risk following high-trauma versus low-trauma fracture: a registry-based cohort study
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DOI：
10.1007/s00198-019-05274-2
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发表时间：
2020-03-16
影响因子：
4
通讯作者：
Kanis, J. A.
中科院分区：
文献类型：
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作者：
Leslie, W. D.;Schousboe, J. T.;Kanis, J. A.
通过卫生服务数据确定的既往高创伤性骨折与低骨矿物质密度 (BMD) 和未来骨折风险的相关性与无高创伤性骨折的程度相同。引言 有些人质疑区分高创伤性骨折和低创伤性骨折的有用性。本研究的目的是比较既往患有高创伤性或低创伤性骨折的患者的 BMD 测量值和随后发生低创伤性骨折的风险。方法 利用加拿大马尼托巴省的临床 BMD 登记处，我们从基于人群的医疗保健数据中确定了有骨折记录的 40 岁或以上的女性和男性。研究了年龄和性别调整后的 BMD Z 分数以及协变量调整后的风险比 (HR) 和 95% 置信区间 (CI) 与既往骨折状态的关系，如果与外部损伤代码相关则分类为高创伤，否则分类为低创伤。结果 研究人群包括 64,428 名既往无骨折史的女性和男性（平均年龄 63.7 岁）、858 名既往患有高创伤性骨折的女性和男性（平均年龄 65.1 岁）和 14,758 名既往患有低创伤性骨折的女性和男性（平均年龄 67.2 岁）。既往有高创伤性骨折的患者的平均 Z 评分显着低于未曾发生骨折的患者 (P < 0.001)，并且与既往低创伤性骨折的患者相似。骨折事件的中位观察时间为 8.8 年（总计 729,069 人年）。任何先前的高创伤性骨折均与发生重大骨质疏松性骨折（MOF）的风险增加显着相关（调整后的 HR 1.31，95% CI 1.08-1.59），与先前的低创伤性骨折（调整后的 HR 1.55，95% CI 1.47-1.63）一样，两组之间没有显着差异（先前的创伤与低创伤性骨折 P = 0.093）。当研究事件 MOF 与先前髋部骨折或先前 MOF 的关系时，或者当结果是事件髋部骨折或任何事件骨折时，会看到类似的模式。结论 高创伤性和低创伤性骨折与低 BMD 和未来骨折风险具有相似的关系。这支持将高创伤性骨折纳入潜在骨质疏松症的临床评估以及降低未来骨折风险的干预措施评估中。
Prior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma. Introduction Some have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures. Methods Using a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise. Results The study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08-1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47-1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture. Conclusions High-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk.