Progressively Increasing Fracture Risk With Advancing Age After Initial Incident Fragility Fracture: The Tromso Study
Progressively Increasing Fracture Risk With Advancing Age After Initial Incident Fragility Fracture: The Tromso Study
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DOI：
10.1002/jbmr.1952
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发表时间：
2013-10-01
影响因子：
6.2
通讯作者：
Emaus, Nina
中科院分区：
文献类型：
--
作者：
Ahmed, Luai Awad;Center, Jacqueline R.;Emaus, Nina
初次骨折后，后续骨折的风险会增加；然而，人们对其规模缺乏正确的认识。这项基于人群的研究根据年龄和初始骨折类型检查了女性和男性的后续骨折风险。挪威 TromsO 研究的 27,158 名参与者记录了 1994 年至 2009 年间发生的所有非椎骨骨折。该分析包括 3108 名 49 岁之后首次发生骨折的受试者。随后的骨折 (n=664) 风险以发生率比 (RR) 和绝对比例表示，与死亡无关。初次骨折和后续骨折的发生率都随着年龄的增长而增加，后者的曲线最陡。与女性每 1000 人 30.8 例、男性每 1000 人 12.9 例的初始骨折发生率相比，女性随后骨折的总体年龄调整 RR 为 1.3 (95% CI, 1.2-1.5)，男性为 2.0 (95% CI, 1.6-2.4)。尽管 RR 随着年龄的增长而降低，但初次骨折且随后发生骨折的绝对比例随着年龄的增长而增加；在 50-59 岁至 80 岁以上的年龄组中，女性为 9% 至 30%，男性为 10% 至 26%。随后骨折的类型因年龄而异，从最年轻的大多数为轻微骨折到最大年龄组的髋部或其他主要骨折，无论初始骨折的类型和严重程度如何。在女性和男性中，随后发生的髋部或其他主要骨折中分别有 45% 和 38% 发生在最初的轻微骨折之前。所有年龄段的后续骨折风险都很高。在年龄较大时，严重的后续骨折类型遵循临床严重和轻微的初始骨折。老年人的任何脆性骨折都反映出需要进行特定的骨质疏松症治疗，以进一步降低骨折风险。 (c) 2013 年美国骨与矿物质研究学会。
The risk of subsequent fracture is increased after initial fractures; however, proper understanding of its magnitude is lacking. This population-based study examines the subsequent fracture risk in women and men by age and type of initial incident fracture. All incident nonvertebral fractures between 1994 and 2009 were registered in 27,158 participants in the TromsO Study, Norway. The analysis included 3108 subjects with an initial incident fracture after the age of 49 years. Subsequent fracture (n=664) risk was expressed as rate ratios (RR) and absolute proportions irrespective of death. The rates of both initial and subsequent fractures increased with age, the latter with the steepest curve. Compared with initial incident fracture rate of 30.8 per 1000 in women and 12.9 per 1000 in men, the overall age-adjusted RR of subsequent fracture was 1.3 (95% CI, 1.2-1.5) in women, and 2.0 (95% CI, 1.6-2.4) in men. Although the RRs decreased with age, the absolute proportions of those with initial fracture who suffered a subsequent fracture increased with age; from 9% to 30% in women and from 10% to 26% in men, between the age groups 50-59 to 80+ years. The type of subsequent fracture varied by age from mostly minor fractures in the youngest to hip or other major fractures in the oldest age groups, irrespective of type and severity of initial fracture. In women and men, 45% and 38% of the subsequent hip or other major fractures, respectively, were preceded by initial minor fractures. The risk of subsequent fracture is high in all age groups. At older age, severe subsequent fracture types follow both clinically severe and minor initial incident fractures. Any fragility fracture in the elderly reflects the need for specific osteoporosis management to reduce further fracture risk. (c) 2013 American Society for Bone and Mineral Research.