Risk factors for fractures of the proximal humerus:: results from the EPIDOS prospective study
Risk factors for fractures of the proximal humerus:: results from the EPIDOS prospective study
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DOI：
10.1359/jbmr.2002.17.5.817
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发表时间：
2002-05-01
影响因子：
6.2
通讯作者：
Bréart, G
中科院分区：
文献类型：
--
作者：
Lee, SH;Dargent-Molina, P;Bréart, G
肱骨近端骨折是骨质疏松性骨折中最常见的骨折之一，但对其研究甚少。评估了两种类型的因素(与骨脆性和跌倒相关)，以确定肱骨近端骨折的危险因素，并检查它们之间可能存在的相互作用。受试者为6901名年龄大于或等于75岁的白人女性，她们都参加了EPIDOS骨质疏松性骨折危险因素研究(法国，1992-1998)。基线检查包括测量股骨颈骨密度(BMD)和跟骨超声参数(声速[SOS]和宽带超声衰减[BUA])，进行功能性临床检查，并完成关于健康状况和生活方式的问卷调查。在平均3.6(0.8)年的随访期中，165名女性发生了肱骨骨折。使用多变量COX回归模型，我们确定了三个与骨脆性相关的预测因素--低骨密度(相对风险[RR]=1.4；95%可信区间，1.1-1.7)、低SOS(相对风险=1.3；95%可信区间，1.0-1.6)和母亲髋部骨折史(RR=1.8；95%可信区间，1.0-3.0)--以及四个与跌倒相关的预测因子--既往跌倒(RR=3.0；95%可信区间，1.5-6.1)，低体力活动(RR=2.2；95%可信区间1.1~4.4)、平衡障碍(RR=1.8；95%可信区间1.1~2.9)、肢体疼痛(RR=1.4；95%可信区间1.0~2.1)。这些与跌倒相关的预测因子的效果因BMD水平不同而不同；在患有骨质疏松症(BMD T评分-2.5)的女性中，它们与肱骨近端骨折显著相关，而在非骨质疏松女性中则没有。患有骨质疏松症和低跌倒风险评分的妇女(5.1/1000妇女年)的肱骨近端骨折发生率仅略高于非骨质疏松症妇女(4.6/1000妇女年)，与没有骨质疏松但跌倒危险分数较高的妇女(5.3/1000妇女年)的发生率相似。另一方面，有两种危险因素的妇女的发病率(每1000妇女年12.1例)比只有一种危险因素的妇女高两倍以上。这些结果表明，拥有这两种风险因素的妇女应该得到最优先的预防。
Fracture of the proximal humerus is one of the most frequent fractures attributable to osteoporosis; yet, it has seldom been studied. Two types of factors (related to bone fragility and falls) were evaluated to identify risk factors for proximal humerus fractures as well as to examine possible interactions between them. Subjects were 6901 white women aged greater than or equal to75 years and all participated in the EPIDOS study of risk factors for osteoporotic fractures (France, 1992-1998). The baseline examination included measurements of femoral neck bone mineral density (BMD) and calcaneal ultrasound parameters (speed of sound [SOS] and broadband ultrasound attenuation [BUA]), a functional clinical examination, and completing a questionnaire on health status and lifestyle. During a mean of 3.6 (0.8) years of follow-up, 165 women had a humeral fracture. Using multivariate Cox regression models, we identified three predictors related to bone fragility-low BMD (relative risk [RR] = 1.4; 95% CI, 1.1-1.7), low SOS (RR = 1.3; 95% CI, 1.0-1.6), and maternal history of hip fracture (RR = 1.8; 95% CI, 1.0-3.0)-and four fall-related predictors-a previous fall (RR = 3.0; 95% CI, 1.5-6.1), a low level of physical activity (RR = 2.2; 95% CI, 1.1-4.4), impaired balance (RR = 1.8; 95% CI, 1.1-2.9), and pain in lower limb extremity (RR = 1.4; 95% CI, 1.0-2.1). The effect of these fall-related predictors varied according to the BMD level; they were significantly associated with proximal humerus fractures in women with osteoporosis (BMD T score < -2.5) but not in nonosteoporotic women. The incidence of proximal humerus fracture in women with osteoporosis and a low fall risk score (5.1 per 1000 woman-years) was only slightly higher than in nonosteoporotic women (4.6 per 1000 woman-years) and similar to the incidence in women without osteoporosis but a high fall risk score (5.3 per 1000 woman-years). On the other hand, the incidence in women who had both types of risk factors was more than two times higher (12.1 per 1000 woman-years) than in women with only one of the two risk factors. These results suggest that women who have both types of risk factors should receive the highest priority for prevention.