RISK FACTORS FOR FRACTURES AMONG THE ELDERLY

项目2，“老年人骨折的危险因素”，补充了本研究中的病理生理学研究。 计划项目赠款，提供人口的风险因素，和后果， 骨质疏松性骨折我们建议继续专注于更好地识别长期风险因素， 通过对明尼苏达州奥姆斯特德县的居民进行大型历史队列研究， 由于雌激素缺乏和衰老而加剧骨质流失的特定情况（"继发性" 骨质疏松症）。我们还将提供有关骨折发病率趋势和成本的重要最新信息， 这些数据对于量化全国骨质疏松症的公共卫生负担至关重要。这些 由于罗切斯特流行病学项目的独特资源， 链接系统，该系统提供对整个地理定义的 奥姆斯特德县医疗保健支出和利用数据库，该数据库估计 向当地居民提供的所有门诊和住院医疗服务的费用。我们的目标选择 鉴于世界卫生组织对骨折风险的新方法， 评估，确定类风湿性关节炎（RA）和个人骨折史为关键风险因素。 由于我们的初步数据表明，大多数类风湿关节炎患者在其剩余的生命中不会骨折，我们 不仅将表征高风险个体，还将表征那些可能幸免于难的低骨折风险个体， 昂贵的骨质疏松症治疗。此外，在40岁之前发生的骨折目前被忽视， 骨质疏松症风险评估，因此我们将使用新技术来确定那些患有前臂骨折的人， 儿童期骨折（青年期最常见的骨折）在骨代谢、结构或 正如一些人所建议的那样，持续到成年的力量，以及他们是否有增加的风险， 晚年的骨折需要所有骨骼部位骨折的描述性发病率和成本数据， 相关的策略确定（例如，骨折预防的成本效益）。基于人群的研究 因此，提出的建议将填补我们对年龄相关骨折风险知识的重要空白。 相关性（参见说明）： 由于老龄化人口越来越多地面临毁灭性骨折的风险，因此重要的是 识别高风险个体进行更积极的骨质疏松症管理，同时也表征低风险 这些人可能会适当地节省治疗费用和副作用。最新资料 需要对裂缝频率和成本进行评估，以帮助确定最有效的裂缝预防方法。

Project 2, "Risk Factors for Fracture Among the Elderly," complements the pathophysiology studies in this Program Project Grant by providing a population perspective on risk factors for, and consequences of, osteoporotic fractures. We propose to continue our focus on better identifying risk factors for long-term fracture outcomes by conducting large historical cohort studies of Olmsted County, MN residents with specific conditions that exacerbate bone loss from estrogen deficiency and aging ("secondary" osteoporosis). We also will provide important updated information on fracture incidence trends and cost, data which have been essential for quantifying the public health burden of osteoporosis nationally. These studies are possible due to the unique resources of the Rochester Epidemiology Project, a medical records linkage system which provides access to detailed medical data for an entire geographically-defined population, and the Olmsted County Healthcare Expenditure and Utilization Database, which estimates the cost of all outpatient and inpatient medical care delivered to local residents. Our choice of aims for this funding cycle is especially relevant in light of the new World Health Organization approach to fracture risk assessment, which identifies rheumatoid arthritis (RA) and personal fracture history as key risk factors. Since our preliminary data suggest that most RA patients will not fracture over their remaining lifetimes, we not only will characterize high risk individuals, but also those at low risk for fracture who might be spared costly osteoporosis treatment. Furthermore, fractures occurring before age 40 years are presently ignored in osteoporosis risk assessment so we will use novel technologies to determine if those who suffered a forearm fracture in childhood (the most common fracture in youth) have deficits in bone metabolism, structure, or strength that persist into adulthood, as some have suggested, and whether they are at increased risk for fractures in later life. The descriptive incidence and cost data for fractures at all skeletal sites are needed for related policy determinations (e.g., cost-effectiveness of fracture prophylaxis). The population-based studies proposed will therefore fill important gaps in our knowledge of age-related fracture risk. RELEVANCE (See instructions): Because the aging population is increasingly at risk of devastating osteoporotic fractures, it is important to identify high-risk individuals for more aggressive osteoporosis management, while also characterizing lowrisk individuals who might appropriately be spared treatment expense and side effects. Updated information on fracture frequency and cost is needed to help define the most efficient approaches to fracture prevention.