The Ability of a Single BMD and Fracture History Assessment to Predict Fracture Over 25 Years in Postmenopausal Women: The Study of Osteoporotic Fractures.
The Ability of a Single BMD and Fracture History Assessment to Predict Fracture Over 25 Years in Postmenopausal Women: The Study of Osteoporotic Fractures.
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DOI：
10.1002/jbmr.3194
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Napoli N
中科院分区：
文献类型：
--
作者：
Black DM;Cauley JA;Wagman R;Ensrud K;Fink HA;Hillier TA;Lui LY;Cummings SR;Schousboe JT;Napoli N
骨矿物质密度（BMD）和其他危险因素预测骨折风险的能力已经建立了长达5-10年。然而，它们预测长期风险的价值尚未得到直接研究。我们调查了股骨颈BMD（FnBMD）和骨折史的单一评估是否可以预测20至25年的骨折风险。我们使用的数据来自骨质疏松性骨折研究（SOF），该研究评估了1988-90年7959名年龄≥ 67岁（平均=73.4）女性的BMD和危险因素。髋部骨折的骨折随访持续25年，任何非椎骨骨折的骨折随访持续20年。使用年龄调整的比例风险模型，我们分析了FnBMD的单一基线评估、骨折史和年龄与20-25岁骨折发病率之间的关系。髋部骨折（HF）的25年累积发生率为17.9%;任何非椎骨骨折的20年发生率为46.2%。≥80岁的患者25年HF发生率最高（22.6%），而<70岁的女性为13.9%。单次FnBMD测量强烈预测了25年的长期HF风险：最低BMD四分位数的风险为29.6%，最高BMD四分位数的风险为7.6%[相对危险度（RH）=4.9（95%CI：4.1，6.0）]。FnBMD预测HF，随着时间的推移，从RH/SD 2.6（2.2-3.0）（0-5年）到1.8（1.4-2.4）（20-25年）几乎没有下降。无论年龄从67岁到>80岁，终生HF风险相似（约30%）。髋部骨折史预测髋部骨折仅略优于非椎骨骨折史[RH=1.6（95%CI：1.1，2.2）vs 1.4（95%CI：1.2，1.5）]。骨折病史在25年内仍具有很强的预测性。我们的结论是，一个单一的骨密度和骨折史评估可以预测骨折的风险超过20-25年。HF的长期风险在最老年龄组中仍然极高，支持即使在最老，风险最高的女性中进行风险评估和考虑治疗。
The ability of bone mineral density (BMD) and other risk factors to predict fracture risk is well-established for as long as 5–10 years. However, their value to predict risk over longer term has not been directly studied. We investigated whether a single assessment of femoral neck BMD (FnBMD) and fracture history can predict fracture risk over 20 to 25 years. We used data from the Study of Osteoporotic Fractures (SOF) that assessed BMD and risk factors in 7959 women ≥ age 67 (mean=73.4) in 1988–90. Follow-up for fractures continued for 25 years for hip fracture, and for 20 years for any non-vertebral fracture. Using age-adjusted proportional hazards models, we analyzed the relationships between a single baseline assessment of FnBMD, fracture history and age and 20–25 year fracture incidence. 25 year cumulative incidence of hip fracture (HF) was 17.9%; 20 year incidence of any non-vertebral fracture was 46.2%. 25 year HF incidence was highest in those ≥80 years old (22.6%) compared to 13.9% in women aged <70 years. A single FnBMD measurement strongly predicted long term HF risk to 25 years: 29.6% risk in the lowest BMD quartile vs 7.6% in the highest [relative hazard (RH) =4.9(95%CI:4.1,6.0)]. FnBMD predicted HF with little degradation over time from RH/SD 2.6(2.2–3.0) for 0–5 years to 1.8(1.4–2.4) for 20–25 years. Lifetime HF risk was similar (~30%) regardless of age from 67 to >80. History of hip fracture predicted hip fractures only slightly better than history of non-vertebral fracture [RH=1.6(95%CI:1.1,2.2) vs 1.4(95%CI:1.2,1.5), respectively]. Fracture history remained strongly predictive up to 25 years. We conclude that a single BMD and fracture history assessment can predict fracture risk over 20–25 years. Long-term risk of HF remains extremely high in the oldest age groups, supporting risk assessment and consideration of treatment even in the oldest, highest risk women.
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