Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures
Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures
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DOI：
10.1359/jbmr.1999.14.5.821
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发表时间：
1999-05-01
影响因子：
6.2
通讯作者：
Cummings, SR
中科院分区：
文献类型：
--
作者：
Black, DM;Arden, NK;Cummings, SR
尽管脊椎畸形可以预测未来的脊椎畸形，但对它们预测其他骨质疏松性骨折的能力却知之甚少。在骨质疏松性骨折研究中，我们对9704名年龄在65岁及以上的女性进行了前瞻性研究，调查了普遍存在的椎体畸形和骨质疏松性骨折之间的关系。根据基线脊柱X线片和平均3.7年后的重复脊柱X线片确定普遍的椎体畸形。每4个月用明信片收集一次阑尾骨折，平均8.3年。在随访中，发现了389例新的椎体畸形、464例髋部骨折和574例手腕骨折，普遍存在的椎体畸形与继续存在进一步椎体畸形的风险(相对风险5.4，95%可信区间[CI]4.4，6.6)增加了5倍；随着普遍存在的畸形的数量和严重程度的增加，风险显著增加。同样，髋部和任何非椎体骨折的风险随着基线的普遍畸形而增加，相对风险分别为2.8(95%可信区间2.3，3.4)和1.9(95%可信区间1.7，2.1)。风险随着畸形的数量和严重程度的增加而增加。在调整了年龄和跟骨骨密度(BMD)后，这些相关性仍然显著。虽然手腕骨折的风险略有增加，但在调整了年龄和骨密度后，这并不显著。总而言之，普遍存在的形态计量学定义的椎体畸形预示着未来的椎体和非椎体骨折，包括髋部骨折，但不是腕部骨折。脊柱X线片识别普遍存在的脊椎畸形可能是进一步对女性未来骨折风险进行分类的有用的额外测量。
Although vertebral deformities are known to predict future vertebral deformities, little is known about their ability to predict other osteoporotic fractures. We examined the association between prevalent vertebral deformities and incident osteoporotic fractures in the Study of Osteoporotic Fractures, a prospective study of 9704 women aged 65 years and older. Prevalent vertebral deformities were determined morphometrically from spinal radiographs at baseline and incident deformities from repeat spinal radiographs after a mean of 3.7 years. Appendicular fractures were collected by postcard every 4 months for a mean of 8.3 years. During follow-up, 389 women with new vertebral deformities, 464 with hip fractures, and 574 with wrist fractures were identified, Prevalent vertebral deformities were associated with a 5-fold increased risk (relative risk 5.4, 95% confidence interval [CI] 4.4, 6.6) of sustaining a further vertebral deformity; the risk increased dramatically with both the number and severity of the prevalent deformities. Similarly, the risks of hip and any nonvertebral fractures were increased with baseline prevalent deformity, with relative risks of 2.8 (95% CI 2.3, 3.4) and 1.9 (95% CI 1.7, 2.1), respectively. Risk increased with number and severity of deformities. These associations remained significant after adjustment for age and calcaneal bone mineral density (BMD). Although there was a small increased risk of wrist fracture, this was not significant after adjusting for age and BMD. In conclusion, the presence of prevalent morphometrically defined vertebral deformities predicts future vertebral and nonvertebral fractures, including hip but not wrist fractures. Spinal radiographs identifying prevalent vertebral deformities may be a useful additional measurement to classify further a woman's risk of future fracture.