A random sample cohort study for developing a risk assessment method for vertebral and clinical fractures

我们在2002年进行了基线后6年的随访研究，并在2003年对临床骨折进行了额外的调查。结果如下：(1)符合随访研究条件的受试者1588人，完成研究的受试者1173人（73.9%）。(2)建议减少骨质流失的因素为：维持体重或增加体重，每周运动1次以上，每天喝1杯牛奶以上，每天膳食钙摄入量大于750mg，每周摄入发酵大豆“纳豆”3次以上。(3)我们通过随访时的访谈和对未参加研究的受试者的额外邮寄调查来确定随访期间的偶发性临床骨折。骨折总数121例，其中56例为低能冲击骨折，26例为前臂骨折，3例为髋部骨折。(4)骨质疏松性骨折的发生风险随着脊柱和总骨密度的降低而显著增加，但桡骨远端骨密度的降低不明显。然而，桡骨远端骨密度最低类别发生前臂骨折的风险是骨密度最高类别的8倍，脊柱为4倍，全髋为10倍。(5)测定了VDR基因3端、5端和启动子区多态性的基因型。每个多态性的等位基因频率与之前报道的日本人相似。然而，这两种多态性均未显示出对骨密度和临床骨折发生率的显著影响。然而，基因型和生活方式因素对骨密度有显著的相互作用，即：Fok I多态性与绝经前妇女中学时期的牛奶摄入量或参加体育俱乐部有关，Apa I多态性与绝经后妇女基线时的牛奶摄入量有关。骨质疏松性骨折的风险由骨密度来表示，而不是由本研究中评估的多态性来表示。其他遗传因素的影响应在进一步的研究中进行检查，以实施量身定制的预防骨质疏松症和骨质疏松性骨折。少

We performed in 2002 a follow-up study six years after the baseline and an addition survey for clinical fractures in 2003.The results obtained were as follows :(1)The number of eligible subjects for the follow-up study was 1588 and 1173(73.9%) completed the study.(2)Factors suggested to reduce bone loss were as follows : maintaining or gaining weight, exercise more than once a week, intake of a grass of milk per day or more, dietary calcium intake more than 750mg per day, and intake of fermented soybean, "natto", 3 times a week or more.(3)We determined incident clinical fractures during the follow-up period through the interviews at follow-up and an additional mailing survey for the subjects who did not visit the study. The total number of fracture was 121 including 56 fractures having occurred with low-energy impact, 26 forearm fractures and 3 hip fractures.(4)The risk of osteoporotic fractures significantly increased with the decrease in bone mineral density at the spine and total hi … More p but not at the distal radius. However, the risk of forearm fractures in the lowest bone density category at the distal radius was 8 times higher than that in the highest category and the corresponding risks were 4 at the spine and 10 at the total hip.(5)We determined genotypes of polymorphisms at the 3-end,5-end and promoter region of the VDR gene. The allele frequency of each polymorphism was similar to the previously reported for Japanese. However, either of the polymorphism did not show a significant effect on bone density and incidence of clinical fractures. However, some significant interactions of the genotypes and lifestyle factors on bone density were observed, that is, Fok I polymorphism and milk intake or participation in a sport club in middle school age for premenopaus al women, and Apa I polymorphism and milk intake at baseline in postmenopausal women.The risk of osteoporotic fractures was represented by bone density but not by the polymorphisms evaluated in the present study. Effects of other genetic factors should be examined in further studies to implement a tailor-made prevention against osteoporosis and osteoporotic fractures. Less