Long-term risk of incident vertebral fractures
Long-term risk of incident vertebral fractures
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DOI：
10.1001/jama.298.23.2761
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发表时间：
2007-12-19
影响因子：
120.7
通讯作者：
Cummings, Steven R.
中科院分区：
文献类型：
--
作者：
Cauley, Jane A.;Hochberg, Marc C.;Cummings, Steven R.
脊椎骨折是最常见的脊椎骨折。低骨矿物质密度（BMD）和普遍椎骨骨折的妇女在短期内发生椎骨骨折的风险更大，但其长期椎骨骨折的绝对风险是不确定的。目的通过BMD和15年以上普遍椎骨骨折状态来检查椎骨骨折的绝对风险。设计，设置，和参与者在美国4个临床中心共招募了9704名白色妇女，并参加了骨质疏松性骨折研究，这是一项纵向队列研究。其中，2680人在基线后平均14.9年到诊所就诊，平均年龄为68.8岁，随访时为83.8岁。平均结果测量从侧位脊柱X线片确定的发生椎骨骨折，定义为任何椎骨水平至少减少20%和4 mm。在基线X线片上使用椎体形态测量确定普遍的椎体骨折。采用双能X线吸收法测量全髋和腰椎的骨密度。结果在2680名妇女中，487（18.2%）发生椎骨骨折，包括394例中的163例（41.4%）在基线时存在椎骨骨折，2286名受试者中有324名（14.2%）在基线时没有普遍的椎骨骨折（比值比，4.21; 95%置信区间，3.33- 5.34）。低BMD与椎骨骨折风险增加相关（全髋BMD每降低1个标准差的比值比为1.78 [ 95%置信区间为1.58- 2.00]）。椎骨骨折的绝对风险范围从56%的妇女与全髋骨密度T评分为-2.5或更少，一个普遍的椎骨骨折的9%的妇女与正常的BMD和没有普遍的椎骨fraction.Conclusions低BMD和普遍的椎骨骨折是独立相关的新的椎骨骨折超过15年的后续行动。普遍存在椎骨骨折的女性发生骨折的绝对风险显著增加，特别是如果她们有BMD诊断的骨质疏松症。
Context Vertebral fractures are the most common osteoporotic fracture. Women with low bone mineral density ( BMD) and prevalent vertebral fractures have a greater risk of incident vertebral fractures over the short- term, but their absolute risk of vertebral fracture over the long- term is uncertain.Objective To examine the absolute risk of incident vertebral fracture by BMD and prevalent vertebral fracture status over 15 years.Design, Setting, and Participants A total of 9704 white women were recruited at 4 US clinical centers and enrolled in the Study of Osteoporotic Fractures, a longitudinal cohort study. Of these, 2680 attended a clinic visit an average of 14.9 years after baseline; mean age of 68.8 years at entry and 83.8 years at follow- up.Mean Outcome Measure Incident vertebral fractures identified from lateral spinal radiographs defined as a decrease of at least 20% and 4 mm at any vertebral level. Prevalent vertebral fractures were identified on the baseline radiographs using vertebral morphometry. Bone mineral density was measured at the total hip and lumbar spine using dual- energy x- ray absorptiometry.Results Of the 2680 women, 487 ( 18.2%) had an incident vertebral fracture including 163 of the 394 ( 41.4%) with a prevalent vertebral fracture at baseline and 324 of the 2286 ( 14.2%) without a prevalent vertebral fracture at baseline ( odds ratio, 4.21; 95% confidence interval, 3.33- 5.34). Low BMD was associated with an increased risk of incident vertebral fracture ( odds ratio per 1 SD decrease in total hip BMD, 1.78 [ 95% confidence interval, 1.58- 2.00]). The absolute risk of vertebral fracture ranged from 56% among women with total hip BMD T score of - 2.5 or less and a prevalent vertebral fracture to 9% in women with normal BMD and no prevalent vertebral fracture.Conclusions Low BMD and prevalent vertebral fractures are independently related to new vertebral fractures over 15 years of follow- up. Women with a prevalent vertebral fracture have a substantially increased absolute risk of an incident fracture, especially if they have osteoporosis diagnosed by BMD.