Clinical risk factors for osteoporotic fractures in Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)
Clinical risk factors for osteoporotic fractures in Brazilian women and men: the Brazilian Osteoporosis Study (BRAZOS)
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DOI：
10.1007/s00198-008-0680-5
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发表时间：
2009-03-01
影响因子：
4
通讯作者：
Ferraz, M. B.
中科院分区：
文献类型：
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作者：
Pinheiro, M. M.;Ciconelli, R. M.;Ferraz, M. B.
巴西骨质疏松症研究（BRAZOS）是第一个在40岁或以上的巴西男性和女性代表性样本中进行的流行病学研究。脆性骨折的患病率在女性中约为15.1%，在男性中约为12.8%。高龄、久坐不动、髋部骨折家族史、吸烟、反复跌倒、糖尿病和生活质量差是脆性骨折的主要临床危险因素。巴西骨质疏松症研究（BRAZOS）是首个在巴西40岁以上男性和女性的代表性样本中开展的流行病学研究，目的是确定我国人群中与骨质疏松性骨折相关的患病率和主要临床危险因素（CRF）。共有2,420人（女性，70%）来自巴西五个地理区域的150个不同城市，所有不同的社会经济阶层被选中参加本调查。通过个体定量访谈确定人体测量数据以及生活习惯、骨折史、食物摄入、身体活动、跌倒和生活质量。代表性抽样是基于2000年和2003年人口普查提供的巴西国家数据。低创伤性骨折被定义为50岁或以上的个体从站立高度或更低的位置坠落，发生在特定的骨骼部位：前臂、股骨、肋骨、椎骨和肱骨。抽样误差为2.2%，置信区间为95%。设计了以脆性断裂为因变量，其他参数为自变量的Logistic回归分析模型。显著性水平设为p < 0.05。男女平均年龄、身高、体重分别为58.4 +/- 12.8和60.1 +/- 13.7岁，1.67 +/- 0.08和1.56 +/- 0.07 m, 73.3 +/- 14.7和64.7 +/- 13.7 kg。约15.1%的女性和12.8%的男性报告脆性骨折。女性,主要与骨折相关CRF高龄(OR = 1.6; 95%可信区间1.06 - -2.4),髋部骨折的家族史(OR = 1.7; 95%可信区间1.1 - -2.8),早期更年期(OR = 1.7; 95%可信区间1.02 - -2.9),久坐不动的生活方式(OR = 1.6; 95%可信区间1.02 - -2.7),生活质量差(OR = 1.9; 95%可信区间1.2 - -2.9),高摄入磷(OR = 1.9; 95%可信区间1.2 - -2.9)、糖尿病(OR = 2.8; 95%可信区间1.01 - -8.2),使用的苯二氮类药物(OR = 2.0; 95%可信区间1.1 - -3.6)和复发性下降(OR = 2.4;95% ci 1.2-5.0)。在男性中，主要的CRF是生活质量差（OR = 3.2; 95% CI 1.7-6.1）、当前吸烟（OR = 3.5; 95% CI 1.28-9.77）、糖尿病（OR = 4.2; 95% CI 1.27-13.7）和久坐生活方式（OR = 6.3; 95% CI 1.1-36.1）。我们的研究结果表明，CRF可能是识别骨质疏松性骨折高风险男性和女性的重要工具，针对特定风险因素（戒烟、定期体育活动、预防跌倒）的干预可能有助于管理患者，降低骨折风险。
The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older. The prevalence of fragility fractures is about 15.1% in the women and 12.8% in the men. Moreover, advanced age, sedentarism, family history of hip fracture, current smoking, recurrent falls, diabetes mellitus and poor quality of life are the main clinical risk factors associated with fragility fractures.The Brazilian Osteoporosis Study (BRAZOS) is the first epidemiological study carried out in a representative sample of Brazilian men and women aged 40 years or older with the purpose of identifying the prevalence and the main clinical risk factors (CRF) associated with osteoporotic fracture in our population.A total of 2,420 individuals (women, 70%) from 150 different cities in the five geographic regions in Brazil, and all different socio-economical classes were selected to participate in the present survey. Anthropometrical data as well as life habits, fracture history, food intake, physical activity, falls and quality of life were determined by individual quantitative interviews. The representative sampling was based on Brazilian National data provided by the 2000 and 2003 census. Low trauma fracture was defined as that resulting of a fall from standing height or less in individuals 50 years or older at specific skeletal sites: forearm, femur, ribs, vertebra and humerus. Sampling error was 2.2% with 95% confidence intervals. Logistic regression analysis models were designed having the fragility fracture as the dependent variable and all other parameters as the independent variable. Significance level was set as p < 0.05.The average of age, height and weight for men and women were 58.4 +/- 12.8 and 60.1 +/- 13.7 years, 1.67 +/- 0.08 and 1.56 +/- 0.07 m and 73.3 +/- 14.7 and 64.7 +/- 13.7 kg, respectively. About 15.1% of the women and 12.8% of the men reported fragility fractures. In the women, the main CRF associated with fractures were advanced age (OR = 1.6; 95% CI 1.06-2.4), family history of hip fracture (OR = 1.7; 95% CI 1.1-2.8), early menopause (OR = 1.7; 95% CI 1.02-2.9), sedentary lifestyle (OR = 1.6; 95% CI 1.02-2.7), poor quality of life (OR = 1.9; 95% CI 1.2-2.9), higher intake of phosphorus (OR = 1.9; 95% CI 1.2-2.9), diabetes mellitus (OR = 2.8; 95% CI 1.01-8.2), use of benzodiazepine drugs (OR = 2.0; 95% CI 1.1-3.6) and recurrent falls (OR = 2.4; 95% CI 1.2-5.0). In the men, the main CRF were poor quality of life (OR = 3.2; 95% CI 1.7-6.1), current smoking (OR = 3.5; 95% CI 1.28-9.77), diabetes mellitus (OR = 4.2; 95% CI 1.27-13.7) and sedentary lifestyle (OR = 6.3; 95% CI 1.1-36.1).Our findings suggest that CRF may contribute as an important tool to identify men and women with higher risk of osteoporotic fractures and that interventions aiming at specific risk factors (quit smoking, regular physical activity, prevention of falls) may help to manage patients to reduce their risk of fracture.