Risk Factors for Subtrochanteric and Diaphyseal Fractures: The Study of Osteoporotic Fractures
Risk Factors for Subtrochanteric and Diaphyseal Fractures: The Study of Osteoporotic Fractures
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DOI：
10.1210/jc.2012-1896
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发表时间：
2013-02-01
影响因子：
5.8
通讯作者：
Black, Dennis M.
中科院分区：
文献类型：
--
作者：
Napoli, Nicola;Schwartz, Ann V.;Black, Dennis M.
内容：长期接受双膦酸盐治疗的患者可能会增加低能量转子下和股骨干（SD）骨折的发生率。然而，发病率和危险因素与这些fractions.Objective：该研究的目的是确定低能量SD骨折的发病率和危险因素在骨质疏松性骨折（SOF）的研究设计：低能量SD骨折的确定从1986年和2010年之间获得的女性在SOF的影像学报告的审查。在SD骨折中，排除了病理性、假体周围和创伤性骨折。我们使用年龄调整和多变量时间依赖比例风险模型评估SD骨折的风险因素以及股骨颈（FN）和股骨粗隆间（IT）髋部骨折的风险因素。在此后续行动中，只有一小部分曾经使用bisphosphonates.Results：45名妇女持续低能量转子下/骨干股骨骨折超过140 000人年的总随访。SD骨折的发生率为3.2/10000人年，而全髋关节骨折的发生率为110/10000人年。共有约12%的女性在1次或多次访视时报告使用双膦酸盐。在多变量分析中，年龄、全髋骨矿物质密度（BMD）、双膦酸盐使用和糖尿病史是SD骨折的独立危险因素。FN和IT骨折的风险因素包括年龄、BMD和福尔斯跌倒史或既往骨折史。双膦酸盐的使用是保护对FN骨折，而有一个增加的风险SD骨折（危害比2.58，P = 0.049）与双膦酸盐的使用后，调整其他危险因素fraction.Conclusions：在SOF，低能量SD骨折是罕见的发生，远远超过FN和IT骨折。典型的危险因素与FN和IT骨折相关，而只有年龄、全髋BMD和糖尿病史是SD骨折的独立危险因素。此外，尽管SOF研究评估这种关联的能力有限，但双膦酸盐的使用是一个略微显著的预测因素。（J Clin Endocrinol Metab 98：659-667，2013）
Context: Patients on long-term bisphosphonate therapy may have an increased incidence of low-energy subtrochanteric and diaphyseal (SD) femoral fractures. However, the incidence and risk factors associated with these fractures have not been well defined.Objective: The objective of the study was to determine the incidence of and risk factors for low-energy SD fractures in the Study of Osteoporotic Fractures (SOF).Design: Low-energy SD fractures were identified from a review of radiographic reports obtained between 1986 and 2010 in women in the SOF. Among the SD fractures, pathological, periprosthetic, and traumatic fractures were excluded. We assessed risk factors for SD fractures as well as risk factors for femoral neck (FN) and intertrochanteric (IT) hip fractures using both age-adjusted and multivariate time-dependent proportional hazards models. During this follow-up, only a small minority had ever used bisphosphonates.Results: Forty-five women sustained low-energy subtrochanteric/diaphyseal femoral fractures over a total follow-up of 140 000 person-years. The incidence of SD fracture was 3.2 per 10 000 person-years compared with a total hip fracture incidence of 110 per 10 000 person-years. A total of about 12% of women reported bisphosphonate use at 1 or more visits. In multivariate analyses, age, total hip bone mineral density (BMD), bisphosphonate use, and history of diabetes emerged as independent risk factors for SD fractures. Risk factors for FN and IT fractures included age, BMD, and history of falls or prior fractures. Bisphosphonate use was protective against FN fractures, whereas there was an increased risk of SD fractures (hazard ratio 2.58, P = .049) with bisphosphonate use after adjustment for other risk factors for fracture.Conclusions: In SOF, low-energy SD fractures were rare occurrences, far outnumbered by FN and IT fractures. Typical risk factors were associated with FN and IT fractures, whereas only age, total hip BMD, and history of diabetes were independent risk factors for SD fractures. In addition, bisphosphonate use was a marginally significantly predictor although the SOF study has limited ability to assess this association. (J Clin Endocrinol Metab 98: 659-667, 2013)