Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass
Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass
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DOI：
10.1111/j.1532-5415.2000.tb02641.x
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发表时间：
2000-03-01
影响因子：
6.3
通讯作者：
Black, DM
中科院分区：
文献类型：
--
作者：
Ensrud, KE;Thompson, DE;Black, DM
目的：确定低骨量老年妇女普遍存在的椎体畸形与死亡和住院风险之间的关系。设计：前瞻性队列研究。环境：美国有11个临床中心。参与者：共有6459名55 - 81岁的低骨量社区女性参加了骨折干预试验（FIT），这是一项阿仑膦酸钠的多中心临床试验，仅基于存在或不存在现有的放射学椎体畸形，将女性纳入两个研究组之一。有2027名至少有一种椎体畸形的女性被纳入FIT的椎体骨折组，平均随访时间为2.9年，而4432名没有椎体畸形的女性被纳入FIT的临床骨折组，平均随访时间为4.2年。测量方法：在协调中心采用数字化放射形态测量和半定量放射学解释相结合的方法，确定基线侧胸和腰椎x线片上普遍存在的椎体畸形。通过获得所有死亡参与者的原始死亡证明副本来确认死亡。通过不良事件报告记录住院事件；仅由包含“骨折”或“创伤”字样的不良事件引起的住院被排除在分析之外。结果：在随访期间，122名女性死亡，1676名女性至少一次因非单纯骨折原因住院。与没有普遍椎体畸形的妇女相比，普遍畸形的妇女有更高的死亡率（年龄和治疗调整相对危险度1.60,95%可信区间（CI）， 1.10-2.32）和住院率（年龄和治疗调整相对危险度1.18,95% CI, 1.06-1.31）；此外，进一步调整其他因素，包括吸烟状况、身体活动、高血压、冠心病、阻塞性肺病、50岁以后的任何骨折、健康状况、髋关节总骨密度和体重指数，并没有显著改变普遍椎体畸形与死亡风险之间的关联（多变量相对危险度1.49,95% CI, 1.05-2.21）。调整所有这些因素和糖尿病也没有改变普遍椎体畸形和住院之间的关系（多变量相对危险度1.14,95% CI, 1.02-1.27）。死亡率和住院率随着椎骨畸形发生率的增加而增加（趋势检验P < 0.01）。结论：低骨量老年妇女普遍存在椎体畸形与死亡和住院风险增加相关。只有一部分增加的风险可以用其他已知的预测因素来解释。
OBJECTIVES: To determine the relationship between prevalent vertebral deformities and the risk of mortality and hospitalization in older women with low bone mass.DESIGN: A prospective cohort study.SETTTNG: Eleven clinical centers in the United States.PARTICIPANTS: A total of 6459 community-dwelling women with low bone mass aged 55 to 81 participated in the Fracture Intervention Trial (FIT), a multicenter clinical trial of alendronate that enrolled women into one of two study arms based solely on the presence or absence of existing radiographic vertebral deformities. There were 2027 women with at least one vertebral deformity enrolled in the vertebral fracture arm of FIT and followed prospectively for an average of 2.9 years, whereas 4432 women with no vertebral deformity were enrolled in the clinical fracture arm of FIT and followed prospectively for an average of 4.2 years.MEASUREMENTS: Determination of prevalent vertebral deformities on baseline lateral thoracic and lumbar spine radiographs was made at the coordinating center using a combination of radiographic morphometry by digitization and semiquantitative radiologic interpretation. Deaths were confirmed by obtaining copies of original death certificates of all participants who died. Episodes of hospitalization were captured through adverse event reporting; hospitalizations resulting solely from adverse events containing the words " fracture " or " trauma " were excluded from the analyses.RESULTS: During the follow-up period, 122 women died, and 1676 women were hospitalized on at least one occasion for reasons not related solely to fracture. Compared with women without prevalent vertebral deformities, those women with prevalent deformities had higher risks of mortality (age- and treatment assignment-adjusted relative risk 1.60, 95% confidence interval (CI), 1.10-2.32) and hospitalization (age- and treatment assignment-adjusted relative risk 1.18, 95% CI, 1.06-1.31); In addition, further adjustment for other factors, including smoking status, physical activity, hypertension, coronary heart disease, obstructive lung disease, any fracture since the age of 50, health status, total hip BMD, and body mass index did not alter the association between prevalent vertebral deformities and risk of mortality substantially (multivariate relative risk 1.49, 95% CI, 1.05-2.21). Adjustment for all these factors and diabetes also did not change the relationship between prevalent vertebral deformities and hospitalization (multivariate relative risk 1.14, 95% CI, 1.02-1.27). Rates of mortality and hospitalization increased with increasing number of prevalent vertebral deformities (tests for trend P < .01).CONCLUSIONS: Prevalent vertebral deformities in older women with low bone mass are associated with increased risks of mortality and hospitalization. Only a portion of this increased risk was explained by other known predictors of these outcomes.