Predictive value of BMD for hip and other fractures
Predictive value of BMD for hip and other fractures
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DOI：
10.1359/jbmr.050304
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发表时间：
2005-07-01
影响因子：
6.2
通讯作者：
Tenenhouse, A
中科院分区：
文献类型：
--
作者：
Johnell, O;Kanis, JA;Tenenhouse, A
BMD和骨折风险之间的关系是在对来自12项队列研究的约39，000名男性和女性的数据进行荟萃分析中估计的。低髋部BMD是骨折风险的重要预测因素。髋部骨密度对髋部骨折的预测也依赖于年龄和z score.Introduction：本研究的目的是量化BMD和骨折风险之间的关系，并检查年龄，性别，测量后的时间和初始BMD值的影响。材料和方法：我们研究了来自12个队列的9891名男性和29,082名女性，包括EVOS/EPOS、EPIDOS、OFELY、CaMos、罗切斯特、谢菲尔德、鹿特丹、库奥皮奥、DOES、广岛和来自哥德堡的2个队列。队列随访长达16.3年，共168，366人年。采用Poisson模型分别在每个队列和每个性别中检查BMD对骨折风险的影响。不同的研究结果，然后合并使用加权coefficients.Results：在股骨颈与DXA的BMD测量是一个强大的预测髋部骨折的男性和女性具有类似的预测能力。在65岁时，BMD每降低一个SD，男性风险比增加2.94（95%CI = 2.02-4.27），女性风险比增加2.88（95%CI = 2.31-3.59）。然而，这种影响取决于年龄，50岁的风险梯度明显高于80岁。虽然髋部骨折风险的梯度随着年龄的增长而下降，但绝对风险仍然随着年龄的增长而显著上升。对于任何骨折和任何髋关节骨折，风险梯度低于髋部骨折。在65岁时，BMD每降低一个SD，男性中骨质疏松性骨折的风险增加1.41（95% CI = 1.33-1.51），女性中每降低一个SD，骨质疏松性骨折的风险增加1.38（95% CI = 1.28-1.48）。与髋部骨折风险相比，风险梯度随着年龄的增长而增加。对于任何骨质疏松性骨折（和任何骨折）的预测，BMD越低，风险梯度越高。在z评分为-4 SD时，男性和女性合并的风险梯度为2.10/SD（95% CI = 1.63-2.71），在z评分为-1 SD时，风险为1.73/SD（95% CI = 1.59-1.89）。对于髋部骨折，观察到类似但不太明显和不显著的影响。超声和外周测量数据可从三个队列中获得。这些设备的预测能力略低于DXA测量在股骨颈的年龄，性别，和BMD value.Conclusions：我们得出结论，BMD是骨折的重要性，是一个危险因素，在两性相似。它在国际上的验证允许它在案件查找策略中使用。然而，其使用应考虑到预测值随年龄和BMD的变化。
The relationship between BMD and fracture risk was estimated in a meta-analysis of data from 12 cohort studies of -39,000 men and women, Low hip BMD was an important predictor of fracture risk. The prediction of hip fracture with hip BMD also depended on age and z score.Introduction: The aim of this study was to quantify the relationship between BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value.Materials and Methods: We studied 9891 men and 29,082 women from 12 cohorts comprising EVOS/EPOS, EPIDOS, OFELY, CaMos, Rochester, Sheffield, Rotterdam, Kuopio, DOES, Hiroshima, and 2 cohorts from Gothenburg. Cohorts were followed for up to 16.3 years and a total of 168,366 person-years. The effect of BMD on fracture risk was examined using a Poisson model in each cohort and each sex separately. Results of the different studies were then merged using weighted coefficients.Results: BMD measurement at the femoral neck with DXA was a strong predictor of hip fractures both in men and women with a similar predictive ability. At the age of 65 years, risk ratio increased by 2.94 (95% CI = 2.02-4.27) in men and by 2.88 (95% Cl = 2.31-3.59) in women for each SD decrease in BMD. However, the effect was dependent on age, with a significantly higher gradient of risk at age 50 years than at age 80 years. Although the gradient of hip fracture risk decreased with age, the absolute risk still rose markedly with age. For any fracture and for any osteoporotic fracture, the gradient of risk was lower than for hip fractures. At the age of 65 years, the risk of osteoporotic fractures increased in men by 1.41 per SD decrease in BMD (95% CI = 1.33-1.51) and in women by 1.38 per SD (95% CI = 1.28-1.48). In contrast with hip fracture risk, the gradient of risk increased with age. For the prediction of any osteoporotic fracture (and any fracture), there was a higher gradient of risk the lower the BMD. At a z score of -4 SD, the risk gradient was 2.10 per SD (95 % CI = 1.63-2.71) and at a z score of -1 SD, the risk was 1.73 per SD (95% CI = 1.59-1.89) in men and women combined. A similar but less pronounced and nonsignificant effect was observed for hip fractures. Data for ultrasound and peripheral measurements were available from three cohorts. The predictive ability of these devices was somewhat less than that of DXA measurements at the femoral neck by age, sex, and BMD value.Conclusions: We conclude that BMD is a risk factor for fracture of substantial importance and is similar in both sexes. Its validation on an international basis permits its use in case finding strategies. Its use should, however, take account of the variations in predictive value with age and BMD.