Body mass index as a predictor of fracture risk:: A meta-analysis
Body mass index as a predictor of fracture risk:: A meta-analysis
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DOI：
10.1007/s00198-005-1863-y
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发表时间：
2005-11-01
影响因子：
4
通讯作者：
Tenenhouse, A
中科院分区：
文献类型：
--
作者：
De Laet, C;Kanis, JA;Tenenhouse, A
低体重指数（BMI）是未来骨折的一个已有充分文献记载的风险因素。本研究的目的是从国际视角利用全球数据量化这种影响，并探究BMI与年龄、性别和骨密度（BMD）相关的骨折风险之间的关联。我们研究了来自12个前瞻性基于人群的队列（包括鹿特丹、EVOS/EPOS、CaMos、罗切斯特、谢菲尔德、达博、EPIDOS、OFELY、库奥皮奥、广岛以及来自哥德堡的两个队列）的近60,000名男性和女性的个体参与者数据，总随访超过250,000人年。在每个队列中分别使用泊松回归模型检验了BMI、BMD、年龄和性别对任何骨折、任何骨质疏松性骨折以及单纯髋部骨折风险的影响。然后合并了不同研究的结果。在没有BMD信息的情况下，随着BMI降低，任何类型骨折的年龄调整风险显著增加。总体而言，BMI每增加一个单位，任何骨折的风险比（RR）为0.98（95%置信区间[CI]，0.97 - 0.99），骨质疏松性骨折为0.97（95% CI，0.96 - 0.98），髋部骨折为0.93（95% CI，0.91 - 0.94）（所有p < 0.001）。BMI每单位变化的RR在男性和女性中非常相似（p > 0.30）。在对BMD进行调整后，对于任何骨折或骨质疏松性骨折，这些RR变为1，对于髋部骨折为0.98（在女性中显著）。未对BMD进行调整的骨折风险梯度在BMI值之间并非呈线性分布。相反，BMI低值对骨折风险的影响比高于中位数的值更为显著。这种风险与BMI的非线性关系在髋部骨折风险中最为明显。与BMI为25 kg/m²相比，BMI为20 kg/m²时髋部骨折的风险比几乎增加一倍（RR = 1.95；95% CI，1.71 - 2.22）。相比之下，与BMI为25 kg/m²相比，BMI为30 kg/m²时髋部骨折风险仅降低17%（RR = 0.83；95% CI，0.69 - 0.99）。我们得出结论，低BMI对所有骨折都带来相当重要的风险，该风险在很大程度上与年龄和性别无关，但取决于BMD。BMI作为风险因素的重要性因BMI水平而异。其在国际基础上的验证允许在病例发现策略中使用这一风险因素。
Low body mass index (BMI) is a well-documented risk factor for future fracture. The aim of this study was to quantify this effect and to explore the association of BMI with fracture risk in relation to age, gender and bone mineral density (BMD) from an international perspective using worldwide data. We studied individual participant data from almost 60,000 men and women from 12 prospective population-based cohorts comprising Rotterdam, EVOS/EPOS, CaMos, Rochester, Sheffield, Dubbo, EPIDOS, OFELY, Kuopio, Hiroshima, and two cohorts from Gothenburg, with a total follow-up of over 250,000 person years. The effects of BMI, BMD, age and gender on the risk of any fracture, any osteoporotic fracture, and hip fracture alone was examined using a Poisson regression model in each cohort separately. The results of the different studies were then merged. Without information on BMD, the age-adjusted risk for any type of fracture increased significantly with lower BMI. Overall, the risk ratio (RR) per unit higher BMI was 0.98 (95% confidence interval [CI], 0.97-0.99) for any fracture, 0.97 (95% CI, 0.96-0.98) for osteoporotic fracture and 0.93 (95% CI, 0.91-0.94) for hip fracture (all p < 0.001). The RR per unit change in BMI was very similar in men and women ( p > 0.30). After adjusting for BMD, these RR became 1 for any fracture or osteoporotic fracture and 0.98 for hip fracture (significant in women). The gradient of fracture risk without adjustment for BMD was not linearly distributed across values for BMI. Instead, the contribution to fracture risk was much more marked at low values of BMI than at values above the median. This nonlinear relation of risk with BMI was most evident for hip fracture risk. When compared with a BMI of 25 kg/m(2), a BMI of 20 kg/m(2) was associated with a nearly twofold increase in risk ratio (RR=1.95; 95% CI, 1.71-2.22) for hip fracture. In contrast, a BMI of 30 kg/m(2), when compared with a BMI of 25 kg/m(2), was associated with only a 17% reduction in hip fracture risk (RR=0.83; 95% CI, 0.69-0.99). We conclude that low BMI confers a risk of substantial importance for all fractures that is largely independent of age and sex, but dependent on BMD. The significance of BMI as a risk factor varies according to the level of BMI. Its validation on an international basis permits the use of this risk factor in case-finding strategies.