Relationship of blood lead levels to incident nonspine fractures and falls in older women: The study of osteoporotic fractures
Relationship of blood lead levels to incident nonspine fractures and falls in older women: The study of osteoporotic fractures
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DOI：
10.1359/jbmr.080404
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发表时间：
2008-09-01
影响因子：
6.2
通讯作者：
Cummings, Steven R.
中科院分区：
文献类型：
--
作者：
Khalil, Naila;Cauley, Jane A.;Cummings, Steven R.
铅储存在骨骼中，可以作为内源性来源多年。铅可能通过直接影响骨强度或通过干扰神经肌肉功能和增加福尔斯风险间接影响骨折风险。这项分析的目的是为了检验血铅水平高的女性发生福尔斯和骨折的几率更高的假设。这是一项前瞻性队列研究，纳入了在美国两个研究中心（巴尔的摩）参加骨质疏松性骨折研究的533名65-87岁女性。MD：Monongahela Valley，PA）从1.986至1.988。1990-1991年，用原子吸收分光光度法测量了血铅水平（微克/分升），并将其归类为“低”（= 8;第15百分位数）。两次用DXA测量全髋骨密度，间隔3.55年。每4个月收集一次关于福尔斯的信息，持续4年。在10年内识别并证实了非脊柱骨折事件。采用考克斯比例风险模型估计骨折的风险比（HR）和95%CI。使用广义估计方程计算福尔斯的发生率比（95%CI）。平均血铅水平为5.3 +/- 2.3（SD）μ g/dl（范围，1-21 μ g/dl）。与最低血铅组相比，最高血铅组的全髋骨密度降低7%，股骨颈骨密度降低5%（P < 0.02）。高铅组的髋关节骨丢失倾向于更大，但差异不显著。在多变量校正模型中，与血铅水平最低的女性相比，血铅水平高的女性非脊柱骨折的风险增加（HR = 2.50：95% CI = 1.25 - 5.03; p趋势= 0.016），福尔斯的风险更高（发病率比= 1.62; 95%，CI = 1.07 - 2.45; p趋势= 0.014）。血铅水平与福尔斯和骨折的风险增加有关，将铅的负面健康后果扩展到包括骨质疏松性骨折。
Lead is stored in the skeleton and can serve as an endogenous Source for many years. Lead may influence the risk of fracture, through direct effects on bone strength or indirectly by disturbing neuromuscular function and increasing the risk of falls. The objective of this analysis is to test the hypothesis that women with hi g her blood lead levels experience higher rates of falls and fracture. This vas a prospective cohort study of 533 women 65-87 yr of age enrolled in the Study of Osteoporotic Fractures at two U.S. research centers (Baltimore. MD: Monongahela Valley, PA) from 1.986 to 1.988. Blood lead levels (in mu g/dl) were measured in 1990-1991 by atomic absorption spectrophotometry and classified as "low" (= 8; upper 15th percentile). Total hip BMD was measured by DXA twice, 3.55 yr apart. Information on falls was collected every 4 mo for 4 yr. Incident nonspine fractures were identified and confirmed over 10 yr. Cox proportional hazards models were used to estimate the hazard ratio (HR) and 95% CI of fracture. Generalized estimating equations were used to calculate the incident rate ratio of falls (95% CI). The mean blood lead level was 5.3 +/- 2.3 (SD) mu g/dl (range, 1-21 mu g/dl). Baseline BMD was 7% lower in total hip and 5% lower in femoral neck in the highest compared with lowest blood lead group (p < 0.02). Hip bone loss tended to be greater in the high lead group, but differences were not significant. In multivariable adjusted models, women with high blood lead levels had an increased risk of nonspine fracture (HR = 2.50: 95% CI = 1.25 5.03; p trend = 0.016) and higher risk of falls (incident rate ratio = 1.62; 95%, CI = 1.07, 2.45; p trend = 0.014) compared with women with lowest lead level. Blood lead levels are associated with an increased risk of falls and fractures, extending the negative health consequences of lead to include osteoporotic fractures.