Risk of subsequent fracture after low-trauma fracture in men and women
Risk of subsequent fracture after low-trauma fracture in men and women
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DOI：
10.1001/jama.297.4.387
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发表时间：
2007-01-24
影响因子：
120.7
通讯作者：
Eisman, John A.
中科院分区：
文献类型：
--
作者：
Center, Jacqueline R.;Bliue, Dana;Eisman, John A.
背景很少有关于随后骨折绝对风险的长期数据发表目的研究男性和女性初次低创伤骨折后继发骨折的长期风险。设计，设置，前瞻性队列研究（杜博骨质疏松流行病学研究）在澳大利亚的2245个社区-从1989年7月至2005年4月，对1760名60岁或以上的男性和女性进行了16年的随访。根据性别、年龄组和首次骨折后的时间划分的（初始）骨折和后续骨折的发生率。通过比较随后骨折的风险与初始fracture.Results的风险，有905名妇女和337名男子与初始fracture. Results的相对风险，其中253名妇女和71名男子经历了随后的骨折。女性患者随后发生骨折的相对危险度（RR）为1.95（95%置信区间[CI]，1.70-2.25），男性患者为3.47（95% CI，2.68-4.48）。因此，女性和男性后续骨折的绝对风险相似，至少与10岁以上女性的初始骨折风险一样大。因此，60 - 69岁女性和男性的绝对再骨折率分别为36/1000人-年（95% CI，26-48/1000）和37/1000人-年（95% CI，23-59/1000）。绝对骨折风险的增加持续了10年，到那时，40%至60%的幸存女性和男性经历了随后的骨折。除了肋骨（男性）和脚踝（女性）之外，所有骨折位置都会导致后续骨折风险增加，其中年轻男性髋部骨折（RR，9.97; 95%CI，1.38-71.98）和临床椎骨骨折（RR，15.12; 95%CI，6.06-37.69）的RR最高。在多变量分析中，股骨颈骨密度，年龄和吸烟的预测因素，随后骨折的妇女和股骨颈骨密度，体力活动，钙摄入量的预测因素，在manifest.Conclusion后，最初的低创伤骨折，随后骨折的绝对风险是相似的男性和女性。几乎所有临床骨折都会出现这种风险增加，并持续长达10年。
Context There are few published long-term data on absolute risk of subsequent fracture ( refracture) following initial low-trauma fracture in women and fewer in men.Objective To examine long-term risk of subsequent fracture following initial osteoporotic fracture in men and women.Design, Setting, and Participants Prospective cohort study (Dubbo Osteoporosis Epidemiology Study) in Australia of 2245 community-dwelling women and 1760 men aged 60 years or older followed up for 16 years from July 1989 through April 2005.Main Outcome Measure Incidence of first ( initial) fracture and incidence of subsequent fracture according to sex, age group, and time since first fracture. Relative risk was determined by comparing risk of subsequent fracture with risk of initial fracture.Results There were 905 women and 337 men with an initial fracture, of whom 253 women and 71 men experienced a subsequent fracture. Relative risk (RR) of subsequent fracture in women was 1.95 (95% confidence interval [CI], 1.70-2.25) and in men was 3.47 ( 95% CI, 2.68-4.48). As a result, absolute risk of subsequent fracture was similar in women and men and at least as great as the initial fracture risk for a woman 10 years older. Thus, women and men aged 60 to 69 years had absolute refracture rates of 36/1000 person-years ( 95% CI, 26-48/1000) and 37/1000 person-years ( 95% CI, 23-59/1000), respectively. The increase in absolute fracture risk remained for up to 10 years, by which time 40% to 60% of surviving women and men experienced a subsequent fracture. All fracture locations apart from rib ( men) and ankle ( women) resulted in increased subsequent fracture risk, with highest RRs following hip ( RR, 9.97; 95% CI, 1.38-71.98) and clinical vertebral ( RR, 15.12; 95% CI, 6.06-37.69) fractures in younger men. In multivariate analyses, femoral neck bone mineral density, age, and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density, physical activity, and calcium intake were predictors in men.Conclusion After an initial low-trauma fracture, absolute risk of subsequent fracture was similar for men and women. This increased risk occurred for virtually all clinical fractures and persisted for up to 10 years.