RISK FACTORS FOR FRACTURES AMONG THE ELDERLY

项目2“老年人骨折的危险因素”补充了这方面的病理生理学研究。 通过提供关于风险因素及其后果的人口视角，计划项目赠款 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 对明尼苏达州奥姆斯特德县患有骨折的居民进行大型历史队列研究的骨折结果 加剧雌激素缺乏和衰老导致的骨丢失的特殊情况(“继发性” 骨质疏松)。我们还将提供有关骨折发生率趋势和成本的重要最新信息， 这些数据对于量化全国范围内骨质疏松症的公共健康负担至关重要。这些 由于罗切斯特流行病学项目的独特资源，这项研究成为可能，这是一项医疗记录 链接系统，提供对整个地理定义的详细医疗数据的访问 人口和奥姆斯特德县医疗支出和利用数据库，该数据库估计 提供给当地居民的所有门诊和住院医疗费用。我们为此选择的目标 鉴于世界卫生组织对骨折风险采取的新办法，资金周期尤其重要 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显示，大多数RA患者在其余生中不会骨折，我们 不仅是高危个体的特征，也是那些可能幸免于骨折的低风险个体的特征 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略 骨质疏松症风险评估所以我们将使用新技术来确定那些遭受前臂损伤的人 儿童期骨折(年轻人最常见的骨折)在骨骼代谢、结构或功能方面存在缺陷 像一些人建议的那样，持续到成年的力量，以及他们是否面临更大的风险 在晚年生活中的骨折。需要所有骨骼部位骨折的描述性发病率和成本数据 相关的政策决定(例如，骨折预防的成本效益)。基于人口的研究 因此，这一建议将填补我们对与年龄相关的骨折风险认识的重要空白。 相关性(请参阅说明)： 由于老龄化人口日益面临破坏性骨质疏松性骨折的风险，因此重要的是 确定高危人群以进行更积极的骨质疏松症治疗，同时也以低风险为特征 可能适当地免除治疗费用和副作用的个人。更新信息 需要对骨折频率和成本进行评估，以帮助确定预防骨折的最有效方法。

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.