The relationship between bone density and incident vertebral fracture in men and women
The relationship between bone density and incident vertebral fracture in men and women
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DOI：
10.1359/jbmr.2002.17.12.2214
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发表时间：
2002-12-01
影响因子：
6.2
通讯作者：
Reeve, J
中科院分区：
文献类型：
--
作者：
O'Neill, TW;Lunt, M;Reeve, J
骨密度（BMD）是预测女性未来骨折风险的重要指标；然而，很少有男性的前瞻性数据。本分析的目的是确定男性和女性骨密度与偶发性椎体骨折之间的关系是否存在差异。研究人员从21个欧洲中心的人口登记册中招募了男性和女性。这些被招募的人接受了采访，并进行了脊柱x光检查。x线片进行形态计量学评估，并使用mcclosky - kanis方法定义普遍的椎体畸形。在基线x线片后平均3.8年进行重复脊柱x线片检查。偶发性骨折的定义采用点发生率和椎体高度降低20%（外加绝对高度降低4mm）的标准。骨密度测量是在被招募者的一个子样本中进行的。采用泊松回归分析探讨性别、年龄、常见畸形和骨密度对椎体骨折发生率的影响。3461名男性和女性同时进行了脊柱x光片和骨密度测量。男性脊柱和股骨颈的骨密度高于女性。经年龄调整后，女性发生椎体骨折的风险高于男性（相对危险度[RR] = 2.3; 95% CI, 1.5-3.6），且每降低0.1 g/cm(2)，脊柱、股骨颈和粗隆的骨密度分别增加1.4 （95% CI, 1.2-1.8）、1.5 （95% CI, 1.2-1.8）和1.6 （95% CI, 1.3-1.9）倍。校正脊柱或粗隆的骨密度后，预测的椎体骨折的年龄特异性发生率的性别差异不再显著（RR = 1.1, 95% CI，脊柱为0.6-1.9;RR = 1.5, 95% CI，粗隆为0.8-2.7），尽管校正股骨颈骨密度后仍然存在（RR = 1.9, 95% CI, 1.1-3.3）。普遍存在的椎体畸形是未来椎体骨折的一个重要危险因素，尽管在调整了年龄、性别和脊柱骨密度后，这种关联的强度降低了。然而，调整基线椎体畸形的存在并没有改变主要发现。总之，在给定的年龄和脊柱（尽管不是股骨颈）骨密度下，男性和女性发生椎体骨折的风险相似。偶发性椎体骨折在女性中比男性更常见，因为在任何年龄，她们的脊柱骨密度都较低。
Bone mineral density (BMD) is an important predictor of future fracture risk in women; however, there are few prospective data in men. The aim of this analysis was to determine whether there are differences in the relationship between BMD and incident vertebral fracture in men and women. Men and women were recruited from population-based registers in 21 European centers. Those recruited were interviewed and had spinal radiographs performed. The radiographs were assessed morphometrically and prevalent vertebral deformity was defined using the McCloskey-Kanis method. Repeat spinal radiographs were performed at a mean of 3.8 years after the baseline radiographs. Incident fractures were defined using a combination of the point prevalence and 20% reduction in vertebral height (plus a 4-mm reduction in absolute height) criteria. BMD measurements were made in a subsample of those recruited. Poisson regression was used to explore the influence of gender, age, prevalent deformity, and BMD on the incidence of vertebral fracture. Thirty-four hundred sixty-one men and women had both paired spinal radiographs and bone density measurements performed. BMD at the spine and femoral neck was higher in men than in women. After adjusting for age, the risk of incident vertebral fracture was greater in women than in men (relative risk [RR] = 2.3; 95% CI, 1.5-3.6) and increased by a factor of 1.4 (95% CI, 1.2-1.8), 1.5 (95% CI, 1.2-1.8), and 1.6 (95% CI, 1.3-1.9) per decrease of 0.1 g/cm(2) in BMD at the spine, femoral neck, and trochanter, respectively. After adjusting for BMD at the spine or trochanter, the gender difference in the predicted age-specific incidence of vertebral fracture was no longer significant (RR = 1.1 and 95% CI, 0.6-1.9 at the spine; RR = 1.5 and 95% CI, 0.8-2.7 at the trochanter), although it persisted after adjusting for femoral neck BMD (RR = 1.9; 95% CI, 1.1-3.3). The presence of a prevalent vertebral deformity was a strong risk factor for future vertebral fracture, although the strength of the association was reduced after adjustment for age, sex, and spine BMD. However, adjustment for the presence of a baseline vertebral deformity did not alter the main findings. In conclusion, at a given age and spine (although not femoral neck) bone density, the risk of incident vertebral fracture is similar in men and women. Incident vertebral fractures are more common in women than men because at any age their spine BMD is lower.