Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women.
Clinical risk factors, bone density and fall history in the prediction of incident fracture among men and women.
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DOI：
10.1016/j.bone.2012.11.006
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发表时间：
2013-02
期刊：
影响因子：
4.1
通讯作者：
Cooper, C.
中科院分区：
文献类型：
--
作者：
Edwards, M. H.;Jameson, K.;Denison, H.;Harvey, N. C.;Sayer, A. Aihie;Dennison, E. M.;Cooper, C.
FRAXtr算法使用临床风险因素（CRF）和骨矿物质密度（BMD）来预测骨折风险，但在计算中不包括福尔斯史。利用赫特福德郡队列研究的结果，我们检查了CRF、BMD和福尔斯病史对骨折预测的相对贡献。我们研究了2299名基线诊所的参与者，包括完成健康问卷和人体测量数据。平均5.5年后（范围2.9- 8.8年），受试者完成了一份详细描述跌倒和骨折史的邮寄问卷。在368名男性和407名女性的亚组中，使用Hologic QDR 4500仪器进行骨密度测定。有骨折史的男性和女性发生骨折的风险显著增加。股骨颈BMD下降一个标准差与男性和女性发生骨折的风险比（HR）（经CRF调整）分别为1.92（1.04-3.54）和1.77（1.16-2.71）。45岁以后的任何跌倒史导致男性和女性骨折的未校正HR分别为7.31（3.78-14.14）和8.56（4.85-15.13）。在ROC曲线分析中，随着BMD和先前的福尔斯被添加到仅使用CRF的初始模型中，预测能力逐渐增加。福尔斯史是骨折的另一个独立危险因素。在评估是否开始骨质疏松症药物治疗时，应考虑福尔斯风险，还应提醒医生有机会直接针对福尔斯风险。
The FRAXtr algorithm uses clinical risk factors (CRF) and bone mineral density (BMD) to predict fracture risk but does not include falls history in the calculation. Using results from the Hertfordshire Cohort Study, we examined the relative contributions of CRFs, BMD and falls history to fracture prediction. We studied 2299 participants at a baseline clinic that included completion of a health questionnaire and anthropometric data. A mean of 5.5 years later (range 2.9-8.8yrs) subjects completed a postal questionnaire detailing fall and fracture history. In a subset of 368 men and 407 women, bone densitometry was performed using a Hologic QDR 4500 instrument. There was a significantly increased risk of fracture in men and women with a previous fracture. A one standard deviation drop in femoral neck BMD was associated with a hazards ratio (HR) of incident fracture (adjusted for CRFs) of 1.92 (1.04-3.54) and 1.77 (1.16-2.71) in men and women respectively. A history of any fall since the age of 45 years resulted in an unadjusted HR of fracture of 7.31(3.78-14.14) and 8.56(4.85-15.13) in men and women respectively. In a ROC curve analysis, the predictive capacity progressively increased as BMD and previous falls were added into an initial model using CRFs alone. Falls history is a further independent risk factor for fracture. Falls risk should be taken into consideration when assessing whether or not to commence medication for osteoporosis and should also alert the physician to the opportunity to target falls risk directly.
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影响因子：
158.5
作者：
Lyles, Kenneth W.;Colon-Emeric, Cathleen S.;Boonen, Steven
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