Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study
Measures of Physical Performance and Muscle Strength as Predictors of Fracture Risk Independent of FRAX, Falls, and aBMD: A Meta-Analysis of the Osteoporotic Fractures in Men (MrOS) Study
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DOI：
10.1002/jbmr.3556
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发表时间：
2018-12-01
影响因子：
6.2
通讯作者：
McCloskey, Eugene
中科院分区：
文献类型：
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作者：
Harvey, Nicholas C.;Oden, Anders;McCloskey, Eugene
肌肉质量、力量和功能的测量可以预测骨折发生的风险，但尚不清楚这些风险信息是否与FRAX（骨折风险评估工具）概率的信息相加。在男性骨质疏松性骨折（MrOS）研究队列（瑞典、中国香港、美国）中，我们调查了DXA测量的体能/表观瘦体重（ALM）是否能预测老年男性的骨折事件，与FRAX概率无关。基线信息包括福尔斯病史、福尔斯和骨折的临床风险因素、股骨颈aBMD和计算的FRAX概率。Poisson回归的扩展被用来研究五个椅子站立的时间、超过6米距离的步行速度、握力、根据身体尺寸调整的ALM之间的关系。（ALM/身高（2）），FRAX概率（严重骨质疏松性骨折[MOF]）伴或不伴股骨颈aBMD，在n = 7531的子集中可用）和偶发MOF（髋关节、临床椎骨、腕关节或肱骨近端）。校正了年龄和基线后时间的相关性，并使用荟萃分析报告为首次发生骨折的风险比（HR）/预测因子的SD增量。研究对象包括美国的5660名男性（平均年龄73.5岁）、瑞典的2764名男性（75.4岁）和香港的1987名男性（72.4岁）。平均随访时间为8.7至10.9年。5个椅子站立时间越长，多器官功能衰竭的风险越大（HR 1.26; 95% CI，1.19至1.34），而步行速度更快（HR 0.85; 95% CI，0.79至0.90）、握力（HR 0.77; 95% CI，0.72至0.82）和ALM/身高（2）（HR 0.85; 95% CI，0.80至0.90）与发生MOF的风险较低相关。调整FRAX后，相关性基本相似，但ALM/身高（2）与MOF之间的相关性减弱（HR 0.92; 95%CI，0.85 - 0.99）。纳入股骨颈aBMD显著减弱了ALM/身高（2）与MOF之间的相关性（HR 1.02; 95% CI，0.96至1.10）。物理性能的措施预测独立的FRAX概率事件骨折。虽然通过纳入aBMD大幅降低了ALM/身高（2）的预测值，但需要进一步研究，这些发现支持在骨折风险评估中考虑身体表现。(c)2018作者骨与矿物质研究杂志由Wiley Periodicals Inc.出版。
Measures of muscle mass, strength, and function predict risk of incident fractures, but it is not known whether this risk information is additive to that from FRAX (fracture risk assessment tool) probability. In the Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, Hong Kong, United States), we investigated whether measures of physical performance/appendicular lean mass (ALM) by DXA predicted incident fractures in older men, independently of FRAX probability. Baseline information included falls history, clinical risk factors for falls and fractures, femoral neck aBMD, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the relationship between time for five chair stands, walking speed over a 6 m distance, grip strength, ALM adjusted for body size (ALM/height(2)), FRAX probability (major osteoporotic fracture [MOF]) with or without femoral neck aBMD, available in a subset of n = 7531), and incident MOF (hip, clinical vertebral, wrist, or proximal humerus). Associations were adjusted for age and time since baseline, and are reported as hazard ratios (HRs) for first incident fracture per SD increment in predictor using meta-analysis. 5660 men in the United States (mean age 73.5 years), 2764 men in Sweden (75.4 years), and 1987 men in Hong Kong (72.4 years) were studied. Mean follow-up time was 8.7 to 10.9 years. Greater time for five chair stands was associated with greater risk of MOF (HR 1.26; 95% CI, 1.19 to 1.34), whereas greater walking speed (HR 0.85; 95% CI, 0.79 to 0.90), grip strength (HR 0.77; 95% CI, 0.72 to 0.82), and ALM/height(2) (HR 0.85; 95% CI, 0.80 to 0.90) were associated with lower risk of incident MOF. Associations remained largely similar after adjustment for FRAX, but associations between ALM/height(2) and MOF were weakened (HR 0.92; 95% CI, 0.85 to 0.99). Inclusion of femoral neck aBMD markedly attenuated the association between ALM/height(2) and MOF (HR 1.02; 95% CI, 0.96 to 1.10). Measures of physical performance predicted incident fractures independently of FRAX probability. Whilst the predictive value of ALM/height(2) was substantially reduced by inclusion of aBMD requires further study, these findings support the consideration of physical performance in fracture risk assessment. (c) 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.