Association of Disease Definition, Comorbidity Burden, and Prognosis With Hip Fracture Probability Among Late-Life Women
Association of Disease Definition, Comorbidity Burden, and Prognosis With Hip Fracture Probability Among Late-Life Women
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DOI：
10.1001/jamainternmed.2019.0682
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发表时间：
2019-08-01
影响因子：
39
通讯作者：
Van Marter, J.
中科院分区：
文献类型：
--
作者：
Ensrud, Kristine E.;Kats, Allyson M.;Van Marter, J.
关键点问题在80岁及以上的女性中，疾病定义、共病负担和预后与5年髋部骨折的概率有什么关系？这项前瞻性队列研究发现，考虑到相互竞争的死亡风险，患有骨质疏松症的女性的5年髋部骨折概率是没有骨质疏松症但骨折风险较高的女性的3倍以上。在髋部骨折概率方面，两组之间的差异在合并疾病数量较多或预后较差的女性中更加明显。这意味着80岁及以上患有骨质疏松症的女性，包括那些并发症较多或预后较差的女性，尽管考虑了相互竞争的死亡风险，但髋部骨折的概率很高，而且可能是最有可能接受预防髋部骨折的药物治疗的群体。这项对1500多名80岁及以上女性进行的队列研究评估了骨质疏松的定义、合并症数量和预后的差异是否与5年髋部骨折的概率有关。重要信息高龄与较少使用药物治疗来预防骨折有关，但对并存和预后的担忧增加了这一年龄组管理骨质疏松的复杂性。目的在80岁以上的女性中，确定疾病定义、合并症的数量和预后与5年髋部骨折概率的关系。设计、环境和参与者这项前瞻性队列研究(4个美国站点)包括1528名社区居住的妇女，被确定为开始骨质疏松症药物治疗的潜在候选者。主要结果和措施每4个月联系一次妇女，以确定生命状况和髋部骨折。计算了五年髋部骨折的概率，考虑了竞争性死亡风险。根据国家骨健康联盟提出的疾病定义标准，参与者被分为两个不同的组：有骨质疏松症(n=761)和没有骨质疏松但骨折风险高(n=767)。共病情况采用自我报告法进行评估。使用死亡率预测指数来评估预后。所有分析都是在2018年3月至2019年1月期间进行的。结果1528名受试者均为女性，平均年龄为84.1岁(3.4岁)。在随访期间，125名(8.0%)女性经历了髋部骨折，287名(18.8%)在经历这一事件之前死亡。在患有骨质疏松症的女性中，5年死亡率为24.9%(95%CI，21.8-28.1)，而在没有骨质疏松但骨折风险较高的女性中，5年死亡率为19.4%(95%CI，16.6-22.3)。在两组患者中，死亡概率类似地增加，合并疾病越多，预后越差。相比之下，在患有骨质疏松症的女性中，5年髋部骨折的概率为13.0%(95%CI，10.7-15.5)，而在没有骨质疏松但骨折风险较高的女性中，5年髋部骨折的概率为4.0%(95%CI，2.8-5.6)。这种差异在合并疾病较多或预后较差的女性中最为明显。例如，在有3种或3种以上并发症的妇女中，骨质疏松妇女的髋部骨折概率为18.1%(95%CI，12.3-24.9)，而非骨质疏松但骨折风险较高的妇女为2.5%(95%CI，1.3-4.2)。结论和关系80岁及以上患有骨质疏松症的女性，包括那些有更多并发症或预后较差的女性，尽管考虑了相互竞争的死亡风险，但仍有很高的5年内发生髋部骨折的可能性。相比之下，在没有骨质疏松症但骨折风险很高的女性中，竞争死亡风险远远超过髋部骨折的可能性，特别是在那些合并疾病更多或预后更差的女性中。
Key PointsQuestionWhat is the association of disease definition, comorbidity burden, and prognosis with 5-year hip fracture probabilities among women 80 years and older? FindingsThis prospective cohort study found that the 5-year hip fracture probability, taking into account the competing risk of death, was over 3-fold higher among women with osteoporosis compared with women without osteoporosis but at high fracture risk. The difference between groups in hip fracture probabilities was even more pronounced in women with a greater number of comorbidities or poorer prognosis. MeaningWomen 80 years and older with osteoporosis, including those with more comorbidities or poorer prognosis, have a high hip fracture probability despite accounting for competing mortality risk and may be the group most likely to be candidates for drug treatment to prevent hip fractures.This cohort study of more than 1500 women 80 years and older evaluated whether differences in the definition of osteoporosis, the number of comorbidities, and the prognosis were associated with 5-year hip fracture probability.ImportanceAdvanced age is associated with lower use of drug treatment to prevent fractures, but concerns about comorbidities and prognosis increase the complexity of managing osteoporosis in this age group. ObjectiveTo determine the association of disease definition, number of comorbidities, and prognosis with 5-year hip fracture probabilities among women who are 80 years and older. Design, Setting, and ParticipantsThis prospective cohort study (4 US sites) included 1528 community-dwelling women identified as potential candidates for initiation of osteoporosis drug treatment. Main Outcomes and MeasuresWomen were contacted every 4 months to ascertain vital status and hip fracture. Five-year hip fracture probability was calculated accounting for competing mortality risk. Participants were classified into 2 distinct groups based on disease definition criteria proposed by the National Bone Health Alliance: with osteoporosis (n=761) and without osteoporosis but at high fracture risk (n=767). Comorbid conditions were assessed by self-report. Prognosis was estimated using a mortality prediction index. All analysis was performed between March 2018 and January 2019. ResultsThe study had 1528 participants, all of whom were women, with a mean (SD) age of 84.1 (3.4) years. During follow-up, 125 (8.0%) women experienced a hip fracture and 287 (18.8%) died before experiencing this event. Five-year mortality probability was 24.9% (95% CI, 21.8-28.1) among women with osteoporosis and 19.4% (95% CI, 16.6-22.3) among women without osteoporosis but at high fracture risk. In both groups, mortality probability similarly increased with more comorbidities and poorer prognosis. In contrast, 5-year hip fracture probability was 13.0% (95% CI, 10.7-15.5) among women with osteoporosis and 4.0% (95% CI, 2.8-5.6) among women without osteoporosis but at high fracture risk. The difference was most pronounced among women with more comorbidities or worse prognosis. For example, among women with 3 or more comorbid conditions, hip fracture probability was 18.1% (95% CI, 12.3-24.9) among women with osteoporosis vs 2.5% (95% CI, 1.3-4.2) among women without osteoporosis but at high fracture risk. Conclusions and RelevanceWomen 80 years and older who have osteoporosis, including those with more comorbidities or poorer prognosis, have a high 5-year probability of hip fracture despite accounting for competing mortality risk. In contrast, among women without osteoporosis but at high fracture risk, competing mortality risk far outweighs hip fracture probability, especially among those with more comorbidities or worse prognosis.