Predictive Value of DXA Appendicular Lean Mass for Incident Fractures, Falls, and Mortality, Independent of Prior Falls, FRAX, and BMD: Findings from the Women's Health Initiative (WHI).
Predictive Value of DXA Appendicular Lean Mass for Incident Fractures, Falls, and Mortality, Independent of Prior Falls, FRAX, and BMD: Findings from the Women's Health Initiative (WHI).
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DOI：
10.1002/jbmr.4239
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
McCloskey E
中科院分区：
文献类型：
--
作者：
Harvey NC;Kanis JA;Liu E;Cooper C;Lorentzon M;Bea JW;Carbone L;Cespedes Feliciano EM;Laddu DR;Schnatz PF;Shadyab AH;Stefanick ML;Wactawski-Wende J;Crandall CJ;Johansson H;McCloskey E
在妇女健康倡议(WHI)中，我们调查了基线双能X射线吸收法(DXA)和附件瘦质量(ALM)与老年绝经后妇女发生骨折、跌倒和死亡率(分别针对每种结果)之间的关系，考虑了骨密度(BMD)、既往跌倒和骨折风险评估工具(FRAX®)的概率。WHI是一项针对绝经后妇女的前瞻性研究，在40个 美国网站进行。我们使用扩展的Poisson回归来研究基线ALM(经高度2校正)与发生的骨折结果之间的关系，这里所示的主要骨质疏松性骨折(MOF：髋部、临床椎体、前臂或肱骨近端)、跌倒和死亡。在ALM/Height2(GR)中，调整了年龄、基线以来的时间和随机化组，或另外调整了股骨颈(FN)骨密度、既往跌倒或FRAX概率(无骨密度的MOF)，并报告为风险梯度(GR：每SD增量首次发生骨折的风险比)。有11,187名女性(平均年龄[SD]为63.3[7.4]岁)的数据。在基础模型中(调整了年龄、随访时间和随机化组)，ALM/Height2越大，发生MOF的风险越低(GR=0.88；95%可信区间[CI]0.83-0.94)。这种关联与先前的跌倒无关，但被FRAX概率减弱。调整FN BMD T评分导致危险关系的减弱和倒置(GR=1.06；95%CI为0.98~1.14)。ALM/Height2和意外跌倒之间没有关联。然而，根据具体的调整，每增加ALM/Height2，在随访期间死亡风险增加7%到15%。在WHI中，与我们在老年男性(男性骨质疏松性骨折[MROS]研究队列)中的发现一致，在调整股骨颈骨密度T评分后，DXA-ALM对未来临床骨折的预测价值减弱(并且可能颠倒)。然而，耐人寻味的积极但温和的ALM/身高2与死亡率之间的关联仍然很强。©2021作者。《骨与矿物研究杂志》由Wiley期刊有限责任公司代表美国骨与矿物研究学会(ASBMR)出版。
In the Women's Health Initiative (WHI), we investigated associations between baseline dual‐energy X‐ray absorptiometry (DXA) appendicular lean mass (ALM) and risk of incident fractures, falls, and mortality (separately for each outcome) among older postmenopausal women, accounting for bone mineral density (BMD), prior falls, and Fracture Risk Assessment Tool (FRAX®) probability. The WHI is a prospective study of postmenopausal women undertaken at 40 US sites. We used an extension of Poisson regression to investigate the relationship between baseline ALM (corrected for height2) and incident fracture outcomes, presented here for major osteoporotic fracture (MOF: hip, clinical vertebral, forearm, or proximal humerus), falls, and death. Associations were adjusted for age, time since baseline and randomization group, or additionally for femoral neck (FN) BMD, prior falls, or FRAX probability (MOF without BMD) and are reported as gradient of risk (GR: hazard ratio for first incident fracture per SD increment) in ALM/height2 (GR). Data were available for 11,187 women (mean [SD] age 63.3 [7.4] years). In the base models (adjusted for age, follow‐up time, and randomization group), greater ALM/height2 was associated with lower risk of incident MOF (GR = 0.88; 95% confidence interval [CI] 0.83–0.94). The association was independent of prior falls but was attenuated by FRAX probability. Adjustment for FN BMD T‐score led to attenuation and inversion of the risk relationship (GR = 1.06; 95% CI 0.98–1.14). There were no associations between ALM/height2 and incident falls. However, there was a 7% to 15% increase in risk of death during follow‐up for each SD greater ALM/height2, depending on specific adjustment. In WHI, and consistent with our findings in older men (Osteoporotic Fractures in Men [MrOS] study cohorts), the predictive value of DXA‐ALM for future clinical fracture is attenuated (and potentially inverted) after adjustment for femoral neck BMD T‐score. However, intriguing positive, but modest, associations between ALM/height2 and mortality remain robust. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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影响因子：
6.3
作者：
Cawthon PM;Manini T;Patel SM;Newman A;Travison T;Kiel DP;Santanasto AJ;Ensrud KE;Xue QL;Shardell M;Duchowny K;Erlandson KM;Pencina KM;Fielding RA;Magaziner J;Kwok T;Karlsson M;Ohlsson C;Mellström D;Hirani V;Ribom E;Correa-de-Araujo R;Bhasin S
通讯作者：
Bhasin S
DOI：
10.1359/jbmr.090807
发表时间：
2010-03
期刊：
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
影响因子：
--
作者：
Lang T;Cauley JA;Tylavsky F;Bauer D;Cummings S;Harris TB;Health ABC Study
通讯作者：
Health ABC Study
影响因子：
6.2
作者：
Harvey, Nicholas C.;Oden, Anders;McCloskey, Eugene
通讯作者：
McCloskey, Eugene
影响因子：
2.5
作者：
Drey, M.;Henkel, M.;Schmidmaier, R.
通讯作者：
Schmidmaier, R.
影响因子：
6.2
作者：
Cawthon, Peggy M.;Blackwell, Terri L.;Marshall, Lynn M.;Fink, Howard A.;Kado, Deborah M.;Ensrud, Kristine E.;Cauley, Jane A.;Black, Dennis;Orwoll, Eric S.;Cummings, Steven R.;Schousboe, John T.
通讯作者：
Schousboe, John T.