Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW).
Effect of co-morbidities on fracture risk: findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW).
复制标题
DOI：
10.1016/j.bone.2012.02.639
复制
发表时间：
2012-06
期刊：
影响因子：
4.1
通讯作者：
GLOW Investigators
中科院分区：
文献类型：
--
作者：
Dennison EM;Compston JE;Flahive J;Siris ES;Gehlbach SH;Adachi JD;Boonen S;Chapurlat R;Díez-Pérez A;Anderson FA Jr;Hooven FH;LaCroix AZ;Lindsay R;Netelenbos JC;Pfeilschifter J;Rossini M;Roux C;Saag KG;Sambrook P;Silverman S;Watts NB;Greenspan SL;Premaor M;Cooper C;GLOW Investigators
更好地认识到并发症和骨折风险之间的关系可能会改进骨折预测算法，如FRAX。我们使用了一项大型的多国队列研究(GLOW)来调查合并疾病对骨折风险的影响。女性完成了一份基线问卷，详细说明了过去的病史，包括共病史和骨折史。每年都会重新联系他们，以确定发生的临床骨折事件。得出了一个共病指数，定义为基线共病的数量。通过卡方检验、May-Hosmer检验、c指数和预测骨折发生率与实际骨折发生率的比较，检验在FRAX危险因素中加入共病指数对预防骨折的影响。在2006年10月至2008年2月期间登记的52,960名有随访数据的妇女中，3224人(6.1%)在两年内遭受了意外骨折。除高胆固醇、高血压、乳糜泻和癌症外，所有记录的并存疾病都与骨折显著相关。与帕金森病的相关性最强(年龄调整后的风险比[HR]：2.2；95%CI：1.6-3.1；P<；0.001)。在以FRAX危险因素为附加预测因子的COX回归模型中，对骨折预测贡献最大的并发症是：帕金森氏病、多发性硬化症、慢性阻塞性肺疾病、骨关节炎和心脏病。在本研究人群中，共病，如共病指数所示，对骨折风险有显著的贡献。帕金森氏病具有特别高的骨折风险；并且共同发病指数的增加与骨折风险的增加相关。在FRAX危险因素中加入共病指数改善了骨折预测。
Greater awareness of the relationship between co-morbidities and fracture risk may improve fracture-prediction algorithms such as FRAX. We used a large, multinational cohort study (GLOW) to investigate the effect of co-morbidities on fracture risk. Women completed a baseline questionnaire detailing past medical history, including co-morbidity history and fracture. They were re-contacted annually to determine incident clinical fractures. A co-morbidity index, defined as number of baseline co-morbidities, was derived. The effect of adding the co-morbidity index to FRAX risk factors on fracture prevention was examined using chi-squared tests, the May-Hosmer test, c index and comparison of predicted versus observed fracture rates. Of 52,960 women with follow-up data, enrolled between October 2006 and February 2008, 3224 (6.1%) sustained an incident fracture over 2 years. All recorded co-morbidities were significantly associated with fracture, except for high cholesterol, hypertension, celiac disease, and cancer. The strongest association was seen with Parkinson’s disease (age-adjusted hazard ratio [HR]: 2.2; 95% CI: 1.6–3.1; P<0.001). Co-morbidities that contributed most to fracture prediction in a Cox regression model with FRAX risk factors as additional predictors were: Parkinson’s disease, multiple sclerosis, chronic obstructive pulmonary disease, osteoarthritis, and heart disease. Co-morbidities, as captured in a co-morbidity index, contributed significantly to fracture risk in this study population. Parkinson’s disease carried a particularly high risk of fracture; and increasing co-morbidity index was associated with increasing fracture risk. Addition of co-morbidity index to FRAX risk factors improved fracture prediction.