Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women - A meta-analysis
Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women - A meta-analysis
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DOI：
10.2106/00004623-200310000-00011
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发表时间：
2003-10-01
影响因子：
5.3
通讯作者：
Boonen, S
中科院分区：
文献类型：
--
作者：
Haentjens, P;Autier, P;Boonen, S
背景：在绝经后女性中，任何骨折史都是未来髋部骨折的重要危险因素。类似的发现是否适用于老年男性仍有待确定。我们对文献进行了系统回顾和荟萃分析，以比较男性和女性手腕或脊柱骨折后发生髋部骨折的相对风险。方法：从 PubMed 数据库和检索到的文章参考列表中识别出 1982 年 1 月至 2002 年 9 月以英语、法语或德语完整发表的研究。我们纳入的队列研究报告，在五十岁或以上的（白人）女性和男性中，与手腕或脊柱轻微创伤相关的骨折是随后发生髋部骨折的危险因素。数据由两名独立评审员提取，并在第二次评审中检查准确性。两位评价者一致解决了评估的差异。结果：本荟萃分析纳入了九项队列研究：五项研究在美国进行，四项在欧洲进行。在所有研究中证明关联的同质性后，使用固定效应荟萃分析来计算具有 95% 置信区间的汇总相对风险。在绝经后女性中，手腕或脊柱骨折后发生髋部骨折的相对风险分别为 1.53（95% 置信区间，1.34 至 1.74；p < 0.001）和 2.20（95% 置信区间，1.92 至 2.51；p < 0.001）。在老年男性中，这些相对风险分别为 3.26（95% 置信区间，2.08 至 5.11；p < 0.001）和 3.54（95% 置信区间，2.01 至 6.23；p < 0.001）。桡骨远端骨折增加男性髋部骨折的相对风险显着高于女性 (p = 0.002)。相反，脊柱骨折的影响在性别之间没有差异（p = 0.11）。使用随机效应方法进行的敏感性分析证实了这些发现的稳健性。结论：这项荟萃分析表明，无论男女，先前的脊柱骨折对随后发生髋部骨折的风险都具有同等重要的影响。然而，科尔斯骨折与随后的髋部骨折之间的前瞻性关联在男性中明显强于绝经后女性。患有 Colles 骨折的男性未来发生髋部骨折的风险很高，应作为预防措施的候选者进行评估。证据级别：预后研究，I-2 级（I 级研究的系统回顾）。有关证据级别的完整描述，请参阅作者须知。
Background: In postmenopausal women, a history of any fracture is an important risk factor for a future hip fracture. Whether similar findings apply to aging men remains to be established. We conducted a systematic review and meta-analysis of the literature to compare men and women with respect to the relative risk of hip fracture after a wrist or spine fracture.Methods: Studies published in full from January 1982 through September 2002 in English, French, or German were identified from the PubMed database and from reference lists of retrieved articles. We included cohort studies that reported fractures associated with minimal trauma of the wrist or spine as a risk factor for a subsequent hip fracture among (white) women and men who were fifty years old or older. Data were extracted by two independent reviewers and were checked for accuracy in a second review. Differences in assessments were resolved by consensus of the two reviewers.Results: Nine cohort studies were included in this meta-analysis: five studies were conducted in the United States and four, in Europe. After homogeneity of association was demonstrated across all studies, a fixed-effects meta-analysis was used to calculate pooled relative risks with 95% confidence intervals. Among postmenopausal women, the relative risks for a future fracture of the hip after a fracture of the wrist or spine were 1.53 (95% confidence interval, 1.34 to 1.74; p < 0.001) and 2.20 (95% confidence interval, 1.92 to 2.51; p < 0.001), respectively. In older men, these relative risks were 3.26 (95% confidence interval, 2.08 to 5.11; p < 0.001) and 3.54 (95% confidence interval, 2.01 to 6.23; p < 0.001), respectively. Fractures of the distal part of the radius increased the relative risk of hip fracture significantly more in men than in women (p = 0.002). The impact of a spine fracture, conversely, did not differ between genders (p = 0.11). Sensitivity analyses with use of random-effects methodology confirmed these findings to be robust.Conclusions: This meta-analysis suggests that a previous spine fracture has an equally important impact on the risk of a subsequent hip fracture in both genders. The prospective association between a Colles fracture and a subsequent hip fracture, however, is significantly stronger among men than among postmenopausal women. Men with a Colles fracture are at high risk for a future hip fracture and should be evaluated as candidates for preventive measures.Level of Evidence: Prognostic study, Level I-2 (systematic review of Level-I studies). See Instructions to Authors for a complete description of levels of evidence.