Risk of subsequent fracture after prior fracture among older women
Risk of subsequent fracture after prior fracture among older women
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DOI：
10.1007/s00198-018-4732-1
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发表时间：
2019-01-01
影响因子：
4
通讯作者：
Curtis, J. R.
中科院分区：
文献类型：
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作者：
Balasubramanian, A.;Zhang, J.;Curtis, J. R.
在 377,561 名遭受骨折的女性医疗保险受益人中，10% 在 1 年内再次骨折，18% 在 2 年内再次骨折，31% 在 5 年内再次骨折。在老年女性发生所有非创伤性骨折（包括非髋部非椎体骨折）后，需要及时进行治疗以降低后续骨折的风险。然而，骨折后治疗率很低。量化老年女性随后发生骨折的迫在眉睫（12-24 个月）的风险可能会澄清早期骨折后管理的必要性。方法这项回顾性队列研究使用了医疗保险管理索赔数据。患有临床骨折（临床椎骨和非椎骨骨折；指数日期）并持续登记指数前 1 年和指数后 1 年（这些时间点的结果为 2 或 5 年）的 65 岁女性均被纳入。随后骨折的累积发生率是从感染后 30 天到感染后 1 年、2 年和 5 年计算的。对于阑尾骨折，仅计算需要住院或手术修复的骨折。死亡被认为是一种竞争风险。结果在 377,561 名女性（210,621 名和 10,969 名女性，2 年和 5 年结果）中，指数后 1 年、2 年和 5 年发生后续骨折的累积风险分别为 10%、18% 和 31%。在年龄为 65-74 岁、首次出现临床椎骨、髋部、骨盆、股骨或锁骨骨折的女性中，以及所有 75 岁女性中，无论初始骨折部位如何（踝关节和胫骨/腓骨除外），7-14% 的患者在 1 年内再次骨折，具体取决于初始骨折部位；风险在 2 年内上升至 15-26%，在 5 年内上升至 28-42%。除那些接受研究的女性外，所有接受研究的女性在 5 年内发生髋部骨折的风险均超过 3%
Among 377,561 female Medicare beneficiaries who sustained a fracture, 10% had another fracture within 1year, 18% within 2years, and 31% within 5years. Timely management to reduce risk of subsequent fracture is warranted following all nontraumatic fractures, including nonhip nonvertebral fractures, in older women.IntroductionPrior fracture is a strong predictor of subsequent fracture; however, postfracture treatment rates are low. Quantifying imminent (12-24 month) risk of subsequent fracture in older women may clarify the need for early postfracture management.MethodsThis retrospective cohort study used Medicare administrative claims data. Women 65years who sustained a clinical fracture (clinical vertebral and nonvertebral fracture; index date) and were continuously enrolled for 1-year pre-index and 1-year (2 or 5years for outcomes at those time points) post-index were included. Cumulative incidence of subsequent fracture was calculated from 30days post-index to 1, 2, and 5years post-index. For appendicular fractures, only those requiring hospitalization or surgical repair were counted. Death was considered a competing risk.ResultsAmong 377,561 women (210,621 and 10,969 for 2- and 5-year outcomes), cumulative risk of subsequent fracture was 10%, 18%, and 31% at 1, 2, and 5years post-index, respectively. Among women age 65-74years with initial clinical vertebral, hip, pelvis, femur, or clavicle fractures and all women 75years regardless of initial fracture site (except ankle and tibia/fibula), 7-14% fractured again within 1year depending on initial fracture site; risk rose to 15-26% within 2years and 28-42% within 5years. Risk of subsequent hip fracture exceeded 3% within 5years in all women studied, except those