PREDICTION OF OSTEOPOROTIC FRACTURES BY POSTURAL INSTABILITY AND BONE-DENSITY
PREDICTION OF OSTEOPOROTIC FRACTURES BY POSTURAL INSTABILITY AND BONE-DENSITY
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DOI：
10.1136/bmj.307.6912.1111
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发表时间：
1993-10-30
影响因子：
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通讯作者：
EISMAN, J
中科院分区：
文献类型：
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作者：
NGUYEN, T;SAMBROOK, P;EISMAN, J
目的：探讨骨密度、生活方式和姿势稳定性等危险因素在预测骨质疏松性骨折中的作用。设计：纵向、流行病学和基于人群的调查。地点：杜博市，新南威尔士州。受试者-1989年1月1日年龄大于或等于60岁的所有杜博居民。主要结果测量-个体受试者的骨折发生率。结果-男性和女性非创伤性骨折的总发病率分别为每年1.9%和3.1%。骨折部位以髋部（18.9%）、桡骨远端（18.5%）、肋骨和肱骨（各占11.9%）、踝和足（分别占9.1%和6.6%）为主。男性和女性骨折的主要预测因素是股骨颈骨密度、身体摇摆和股四头肌力量。年龄、绝经年限、身高、体重和生活方式因素也与骨密度和身体摇摆相关，因此是骨折的间接危险因素。判别函数分析分别正确识别了96%和93%（敏感性88%和81%）的男性和女性，随后发生了非创伤性骨折。基于该模型的预测表明，髋关节骨矿物质密度最低四分位数且身体摇摆度高的女性每年发生骨折的概率为8.4%。与骨密度最高四分位数的女性相比，低姿势摇摆的女性骨折风险增加了近14倍。一个人与所有三个预测在“最高风险”的四分位数有13.1%的骨折风险，每年。结论骨密度，身体摇摆，肌肉力量是独立的和强大的协同预测骨折的发病率。
Objective-To investigate the utility of risk factors such as bone mineral density, lifestyle, and postural stability in the prediction of osteoporotic fractures.Design-Longitudinal, epidemiological, and population based survey.Setting-City of Dubbo, New South Wales.Subjects-All residents of Dubbo aged greater-than-or-equal-to 60 on 1 January 1989.Main outcome measure-Incidence of fracture for individual subjects.Results-The overall incidence of atraumatic fractures in men and women was 1.9% and 3.1% per annum respectively. The predominant sites of fracture were hip (18.9%), distal radius (18.5%), ribs and humerus (11.9% in each case), and ankle and foot (9.1% and 6.6% respectively). Major predictors of fractures in men and women were femoral neck bone mineral density, body sway, and quadriceps strength. Age, years since menopause, height, weight, and lifestyle factors were also correlated with bone mineral density and body sway and hence were indirect risk factors for fracture. Discriminant function analysis correctly identified 96% and 93% (sensitivities 88% and 81%) of men and women, respectively, who subsequently developed atraumatic fractures. Predictions based on this model indicated that a woman with a bone mineral density in the lowest quartile in the hip together with high body sway had a 8.4% probability of fracture per annum. This represented an almost 14-fold increase in risk of fracture compared with a woman in the highest bone mineral density quartile with low postural sway. An individual with all three predictors in the ''highest risk'' quartile had a 13.1% risk of fracture per annum.Conclusions-Bone mineral density, body sway, and muscle strength are independent and powerful synergistic predictors of fracture incidence.