More broken bones: A 4-year double cohort study of young girls with and without distal forearm fractures
More broken bones: A 4-year double cohort study of young girls with and without distal forearm fractures
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DOI：
10.1359/jbmr.2000.15.10.2011
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发表时间：
2000-10-01
影响因子：
6.2
通讯作者：
Williams, SM
中科院分区：
文献类型：
--
作者：
Goulding, A;Jones, IE;Williams, SM
此前尚未研究过儿童骨折的预测因素。本研究旨在确定既往前臂骨折病史、低骨矿物质密度（BMD；面积骨矿物质密度 [aBMD，g/cm(2)] 和体积骨矿物质表观密度 [BMAD，g/cm(3)]）或人体测量是否会影响年轻女孩的骨折风险。在基线时，对两组 3-15 岁的女孩进行了评估：其中 100 名最近前臂骨折（第 1 组），100 名未骨折（第 2 组）。四年后，我们重新研究了其中 170 名女孩（82 名来自第一组，88 名来自第二组）。我们现在报告既往骨折史、基线 BMD（通过双能 X 射线骨密度测定法测量）、基线体重和身高与新骨折风险的关系。第 1 组发生的新骨折（24 名女孩中的 37 处骨折）多于第 2 组（7 名女孩中的 8 处骨折；p = 0.0007）。在调整年龄、体重、全身 aBMD 和骨折史的多变量模型中，任何骨骼部位发生新骨折的独立预测因素是既往骨折（风险比 [HR]，3.28；95% CI，1.41-7.64）；年龄（每增加 1 年 HR，0.91；95% CI，0.84-0.99）；全身 aBMD（HR 每降低 1 SD，1.92；95% CI，1.31-2.81）；和体重（HR 每增加 1 SD，1.49；95% CI，1.06-2.08）。同时具有两种危险因素的女孩骨折风险显着更高：既往骨折且脊柱 BMAD 较低（HR，9.4；95% CI，2.8-32.0），既往骨折且体重较高（HR，10.2；95% CI，2.8-37.6），或既往骨折且全身 aBMD 较低（HR，13.0；95% CI，3.9-43.1）。我们得出的结论是，既往前臂骨折、全身 aBMD 较低、脊柱 BMAD 较低和体重较高都会增加年轻女孩 4 年内新发骨折的风险。降低女孩骨折风险的干预措施，特别是前臂骨折，值得进一步研究。
Predictors of childhood fractures have not been investigated previously. This study was undertaken to determine whether a previous history of forearm fracture, low bone mineral density (BMD; both areal bone mineral density [aBMD, g/cm(2)] and volumetric bone mineral apparent density [BMAD, g/cm(3)]), or anthropometry, influence fracture risk in young girls. At baseline, two cohorts of girls, aged 3-15 years, were evaluated: 100 had recently broken a forearm (group 1) and 100 were fracture free (group 2). Four years later we restudied 170 of these girls (82 from group 1 and 88 from group 2). We now report the relationships of previous fracture history, baseline BMD (measured by dual-energy X-ray absorptiometry), baseline weight, and height to risk of new fracture. More new fractures occurred in group 1 (37 fractures in 24 girls) than in group 2 (8 fractures in 7 girls; p = 0.0007). The independent predictors for occurrence of a new fracture at any skeletal site in a multivariate model adjusting for age, weight, total body aBMD, and fracture history were previous fracture (hazard ratio [HR], 3.28; 95% CI, 1.41-7.64); age (HR per 1-year increase, 0.91; 95% CI, 0.84-0.99); total body aBMD (HR per 1 SD decrease, 1.92; 95% CI, 1.31-2.81); and body weight (HR per 1 SD increase, 1.49; 95% CI, 1.06-2.08). Girls with two risk factors together had substantially greater fracture risk: previous fracture and low spinal BMAD (HR, 9.4; 95% CI, 2.8-32.0), previous fracture and high body weight (HR, 10.2; 95% CI, 2.8-37.6), or previous fracture and low total body aBMD (HR, 13.0; 95% CI, 3.9-43.1). We conclude that previous forearm fracture, low total body aBMD, low spinal BMAD, and high body weight each increase risk of new fractures within 4 years in young girls. Interventions to reduce the risk of fractures, particularly forearm fractures, in girls warrant further study.