PREEXISTING FRACTURES AND BONE MASS PREDICT VERTEBRAL FRACTURE INCIDENCE IN WOMEN
PREEXISTING FRACTURES AND BONE MASS PREDICT VERTEBRAL FRACTURE INCIDENCE IN WOMEN
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DOI：
10.7326/0003-4819-114-11-919
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发表时间：
1991-06-01
影响因子：
39.2
通讯作者：
WASNICH, RD
中科院分区：
文献类型：
--
作者：
ROSS, PD;DAVIS, JW;WASNICH, RD
目的：为了确定骨量和现有骨折作为新的椎骨fractures.Subjects风险的预测因子的独立贡献：绝经后日裔美国妇女。测量：基线测量的远端半径，近端半径，跟骨是在1981年获得使用单光子吸收法。1984年采用双光子吸收法测量腰椎。使用侧位X光片测量的尺寸来识别常见的椎骨骨折;椎骨高度值低于椎骨特定平均值超过3 SD被认为表明骨折。统计模型被用来评估骨质量和现有的（普遍）骨折的效用，以预测在平均随访4.7年的新骨折的风险。主要结果：2 SD的骨量差异与新的椎骨骨折的风险增加4倍至6倍。基线检查时的单一骨折使新发椎骨骨折的风险增加5倍。基线时存在两处或两处以上骨折的风险增加12倍。与骨量最高（高于第67百分位）且无骨折的女性相比，低骨量（低于第33百分位）和存在两种或更多种骨折的女性的风险增加了75倍。身高、体重指数、臂展和脊柱状况（如脊柱侧凸、骨关节炎和骶髂关节炎）不能预测骨折发生率（P > 0.05）。体重对骨折发生率有轻微的预测作用（P = 0.04），但调整骨量后无预测作用（P > 0.05）。结论：骨量和椎体骨折均是新椎体骨折风险的有力预测因子。结合有关骨量和普遍骨折的信息似乎比单独使用任何一个变量更能预测新骨折。医生可以使用这些风险因素来识别新发骨折风险最高的患者。
Objective: To determine the independent contributions of bone mass and existing fractures as predictors of the risk for new vertebral fractures.Subjects: Postmenopausal Japanese-American women.Measurements: Baseline measurements of the distal radius, the proximal radius, and the calcaneus were obtained in 1981 using single-photon absorptiometry. Measurements of the lumbar spine were obtained in 1984 using dual-photon absorptiometry. Prevalent vertebral fractures were identified using dimensions measured on lateral radiographs; vertebral height values more than 3 SD below vertebra-specific means were considered to indicate fracture. Statistical models were used to evaluate the utility of bone mass and existing (prevalent) fractures to predict the risk for new fractures during an average follow-up of 4.7 years.Main Results: Differences of 2 SD in bone mass were associated with fourfold to sixfold increases in the risk for new vertebral fractures. A single fracture at the baseline examination increased the risk for new vertebral fractures fivefold. Presence of two or more fractures at baseline increased the risk 12-fold. A combination of low bone mass (below the 33d percentile) and the presence of two or more prevalent fractures increased the risk 75-fold, relative to women with the highest bone mass (above the 67th percentile) and no prevalent fractures. Stature, body mass index, arm span, and spinal conditions such as scoliosis, osteoarthritis, and sacroiliitis did not predict fracture incidence (P > 0.05). Weight was marginally predictive (P = 0.04) of fracture incidence but became nonpredictive after adjusting for bone mass (P greater-than-or-equal-to 0.05).Conclusions: Both bone mass and prevalent vertebral fractures are powerful predictors of the risk for new vertebral fractures. Combining information about bone mass and prevalent fracture appears to be better for predicting new fractures than either variable alone. Physicians can use these risk factors to identify patients at greatest risk for new fractures.