Melton L J, Atkinson E J, Cooper C, O'Fallon W M, Riggs B L
Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Osteoporos Int. 1999;10(3):214-21. doi: 10.1007/s001980050218.
This population-based study documents an increase in most types of fractures following the occurrence of a clinically recognized vertebral fracture among 820 Rochester, Minnesota, residents. During 4349 person-years of follow-up, 896 new fractures were observed. Relative to incidence rates in the community, there was a 2.8-fold increase in the risk of any fracture, which was greater in men (standardized incidence ratio (SIR), 4.2; 95% CI, 3.2-5.3) than women (SIR, 2.7; 95% CI, 2.4-3.0). The estimated cumulative incidence of any fracture after 10 years was 70%. The greatest increase in risk was for subsequent fractures of the axial skeleton, in particular a 12.6-fold increase (95% CI, 11-14) in additional vertebral fractures. There was a lesser increase in most limb fractures, including a 2.3-fold increase (95% CI, 1.8-2.9) in hip fractures and a 1.6-fold increase (95% CI, 1.01-2.4) in distal forearm fractures. There was a slightly greater association with distal forearm fractures among those whose first vertebral fracture occurred before age 70 years but a similar relationship with hip fractures, including cervical and intertrochanteric hip fractures separately, regardless of age at the initial vertebral fracture. There was also an equivalent increase in subsequent fracture risk whether the initial vertebral fracture was attributed to severe or moderate trauma. These data show that vertebral fractures represent an important risk factor for fractures in general, not just those of the spine and hip.
这项基于人群的研究记录了明尼苏达州罗切斯特市820名居民在发生临床诊断的椎体骨折后，大多数类型骨折的发生率有所增加。在4349人年的随访期间，共观察到896例新发骨折。与社区发病率相比，任何骨折的风险增加了2.8倍，男性（标准化发病率比（SIR），4.2；95%可信区间，3.2 - 5.3）高于女性（SIR，2.7；95%可信区间，2.4 - 3.0）。10年后任何骨折的估计累积发病率为70%。风险增加最大的是轴向骨骼的后续骨折，尤其是额外椎体骨折增加了12.6倍（95%可信区间，11 - 14）。大多数四肢骨折的增加幅度较小，包括髋部骨折增加了2.3倍（95%可信区间，1.8 - 2.9），前臂远端骨折增加了1.6倍（95%可信区间，1.01 - 2.4）。首次椎体骨折发生在70岁之前的人群中，前臂远端骨折的关联略强，但髋部骨折的关联相似，包括分别考虑颈椎和转子间髋部骨折，无论初次椎体骨折时的年龄如何。无论初次椎体骨折是由严重创伤还是中度创伤引起，后续骨折风险的增加幅度相同。这些数据表明，椎体骨折是一般骨折的重要危险因素，而不仅仅是脊柱和髋部骨折的危险因素。
