Arden N K, Nevitt M C, Lane N E, Gore L R, Hochberg M C, Scott J C, Pressman A R, Cummings S R
University of California, San Francisco, USA.
Arthritis Rheum. 1999 Jul;42(7):1378-85. doi: 10.1002/1529-0131(199907)42:7<1378::AID-ANR11>3.0.CO;2-I.
To examine the association between osteoarthritis (OA), as defined by radiographic evidence and self report, and osteoporotic fractures, falls, and bone loss in a cohort of elderly white women.
A cohort of 5,552 elderly women from the Study of Osteoporotic Fractures was followed up prospectively for a mean of 7.4 years. Self-reported, physician-diagnosed OA was recorded at interview, and radiologic OA of the hip and hand were defined from pelvis and hand radiographs obtained at baseline by validated techniques. Prevalent and incident vertebral fractures were detected by vertebral morphometry, and data on incident fractures and falls were collected by postcard surveys; fractures were confirmed by radiography. Bone mineral density (BMD) was measured on 2 occasions at the hip, lumbar spine, and calcaneus, and rates of bone loss were calculated.
Women with radiographic hip OA had a reduced risk of recurrent falls in the first year (relative risk [RR] 0.7, 95% confidence interval [95% CI] 0.5-0.95). However, those with self-reported OA had an increased risk of falls (RR 1.4, 95% CI 1.2-1.5). Radiographic hip OA was associated with reduced bone loss in the femoral neck compared with controls (mean +/- SD -0.29+/-0.09%/year versus -0.51+/-0.03%/year; P = 0.018). However, radiographic hip OA showed nonsignificant trends toward increased bone loss at the calcaneus and lumbar spine. There was no significant association between self-reported OA or radiographic hand OA with bone loss. No definition of OA was associated with incident nonvertebral fracture, hip fracture, or vertebral fracture.
Despite having increased BMD compared with controls, subjects with OA did not have a significantly reduced risk of osteoporotic fracture, although there was a trend toward a reduced risk of femoral neck fractures in subjects with severe radiographic OA. The failure of the observed increase in BMD to translate into a reduced fracture risk may be due, in part, to the number and type of falls sustained by subjects with OA. Patients with OA should not be considered to be at a lower risk of fracture than the general population. Physicians should be aware that a high BMD in patients with OA may be falsely reassuring.
通过影像学证据和自我报告来界定骨关节炎（OA），并研究老年白人女性队列中OA与骨质疏松性骨折、跌倒及骨质流失之间的关联。
对来自骨质疏松性骨折研究的5552名老年女性队列进行了平均7.4年的前瞻性随访。在访谈时记录自我报告的、医生诊断的OA，并通过经过验证的技术，根据基线时获得的骨盆和手部X光片来定义髋部和手部的放射学OA。通过椎体形态测量法检测现患和新发椎体骨折，并通过明信片调查收集新发骨折和跌倒的数据；骨折通过X光检查确诊。在髋部、腰椎和跟骨进行了两次骨密度（BMD）测量，并计算骨质流失率。
患有放射学髋部OA的女性在第一年再次跌倒的风险降低（相对风险[RR]0.7，95%置信区间[95%CI]0.5 - 0.95）。然而，那些自我报告有OA的女性跌倒风险增加（RR 1.4，95%CI 1.2 - 1.5）。与对照组相比，放射学髋部OA与股骨颈骨质流失减少相关（平均±标准差 -0.29±0.09%/年对 -0.51±0.03%/年；P = 0.018）。然而，放射学髋部OA在跟骨和腰椎处骨质流失增加方面显示出不显著的趋势。自我报告的OA或放射学手部OA与骨质流失之间无显著关联。没有任何OA的定义与新发非椎体骨折、髋部骨折或椎体骨折相关。
尽管与对照组相比OA患者的骨密度有所增加，但OA患者骨质疏松性骨折的风险并未显著降低，不过在严重放射学OA患者中股骨颈骨折风险有降低的趋势。观察到的骨密度增加未能转化为骨折风险降低，部分原因可能是OA患者跌倒的次数和类型。OA患者不应被认为骨折风险低于一般人群。医生应意识到OA患者骨密度高可能会产生错误的安心感。
