Weight change and fractures in older women
Weight change and fractures in older women
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DOI：
10.1001/archinte.157.8.857
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发表时间：
1997-04-28
影响因子：
--
通讯作者：
Cummings, SR
中科院分区：
文献类型：
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作者：
Ensrud, KE;Cauley, J;Cummings, SR
背景：老年体重变化对骨质疏松性骨折风险的影响尚不确定。先前的研究只评估了体重变化和髋部骨折风险之间的关系，并没有检查体重减轻和髋部骨折风险增加之间的联系是由于自愿还是非自愿的体重减轻。目的：确定老年妇女体重变化与骨折风险之间的关系，并评估减肥意图对这种关系的影响。方法：对6754名65岁及以上的非黑人女性进行体重变化与骨折风险之间的相关性评估，这些女性在基线和第四次检查中都进行了体重测量（平均，检查间隔5.7年）。这6754名女性在第四次检查后随访了所有发生的非脊柱骨折和脆性骨折（定义为股骨近端、骨盆和肱骨近端骨折）（平均随访19.5个月）。所有骨折均经x线报告证实。结果：在第四次检查后平均19.5个月，264名女性（4%）发生至少1次非脊柱骨折，其中83名女性发生脆性骨折。调整年龄后，在基线和第四次检查之间体重减轻的女性随后发生非脊柱骨折的风险增加（体重每减少10%的相对风险[RR]为1.32；95%可信区间[CI]为1.11-1.55）。观察到的非脊柱骨折风险的增加完全是由脆性骨折风险的增加引起的（年龄调整后的相对危险度每体重减少10%，1.86;95% CI, 1.42-2.43）。体重变化与其他类型的非脊柱骨折无显著相关（体重每减少10%的年龄校正RR为1.09；95% CI为0.90-1.33）。进一步调整吸烟、体力活动、雌激素使用、医疗条件、健康状况、体重、股骨颈骨量和跟骨骨量变化率并没有显著改变体重变化与脆性骨折之间的关系（体重每减少10%的多变量RR， 1.68; 95% CI, 1.17-2.41）。对于那些没有尝试减肥的女性，体重变化是脆性骨折风险的一个更强的预测因子（每体重减少10%的多变量RR， 1.81; 95% CI, 1.26-2.61）。结论：老年女性非自愿体重减轻大大增加了脆性骨折（包括髋部骨折）的风险。体重变化与老年妇女发生其他非脊柱骨折的风险无关。
Background: The effect of change in weight in later years on risk of osteoporotic fractures is uncertain. Prior studies have assessed the relationship between weight change and risk of hip fracture only and have not examined whether the association between weight loss and increased risk of hip fracture is because of voluntary or involuntary weight loss.Objectives: To determine the association between weight change in later years and the risk of fractures in elderly women and to assess the effect of weight loss intention on this relationship.Methods: The association between weight change and fracture risk was assessed in 6754 ambulatory, nonblack women aged 65 years or older enrolled in the Study of Osteoporotic-Fractures who had measurements of weight performed at both the baseline and fourth examinations (mean, 5.7 years between examinations). These 6754 women were followed up for all incident nonspine fractures and frailty fractures (defined as fractures of the proximal femur, pelvis, and proximal humerus) occurring after the fourth examination (average follow-up, 19.5 months). All incident fractures were confirmed by radiographic report.Results: During an average of 19.5 months after the fourth examination, 264 women (4%) had at least 1 nonspine fracture, including 83 women who suffered frailty fractures. After adjustment for age, women who lost weight between the baseline and fourth examinations had an increased risk of subsequent nonspine fracture (relative risk [RR] per 10% decrease in weight, 1.32; 95% confidence interval [CI], 1.11-1.55). This observed increase in the risk of nonspine fracture was entirely caused by an increase in the risk of frailty fracture (age-adjusted RR per 10% decrease in weight, 1.86; 95% CI, 1.42-2.43). Weight change was not significantly related to other types of nonspine fractures (age-adjusted RR per 10% decrease in weight, 1.09; 95% CI, 0.90-1.33). Further adjustment for cigarette smoking, physical activity, estrogen use, medical conditions, health status, body weight, femoral neck bone mass, and rate of change in calcaneal bone mass did not substantially alter the association between weight change and frailty fracture (multivariate RR per 10% decrease in weight, 1.68; 95% CI, 1.17-2.41). Weight change was an even stronger predictor of risk of frailty fracture in those women who were not trying to lose weight (multivariate RR per 10% decrease in weight, 1.81; 95% CI, 1.26-2.61).Conclusions: Involuntary weight loss in later years substantially increases the risk of frailty fracture including hip fracture in elderly women. Weight change is not related to risk of other nonspine fractures in older women.