Ensrud K E, Thompson D E, Cauley J A, Nevitt M C, Kado D M, Hochberg M C, Santora A C, Black D M
Minneapolis Veterans Affairs Medical Center, Department of Medicine, University of Minnesota, 55417, USA.
J Am Geriatr Soc. 2000 Mar;48(3):241-9. doi: 10.1111/j.1532-5415.2000.tb02641.x.
To determine the relationship between prevalent vertebral deformities and the risk of mortality and hospitalization in older women with low bone mass.
A prospective cohort study.
Eleven clinical centers in the United States.
A total of 6459 community-dwelling women with low bone mass aged 55 to 81 participated in the Fracture Intervention Trial (FIT), a multicenter clinical trial of alendronate that enrolled women into one of two study arms based solely on the presence or absence of existing radiographic vertebral deformities. There were 2027 women with at least one vertebral deformity enrolled in the vertebral fracture arm of FIT and followed prospectively for an average of 2.9 years, whereas 4432 women with no vertebral deformity were enrolled in the clinical fracture arm of FIT and followed prospectively for an average of 4.2 years.
Determination of prevalent vertebral deformities on baseline lateral thoracic and lumbar spine radiographs was made at the coordinating center using a combination of radiographic morphometry by digitization and semiquantitative radiologic interpretation. Deaths were confirmed by obtaining copies of original death certificates of all participants who died. Episodes of hospitalization were captured through adverse event reporting; hospitalizations resulting solely from adverse events containing the words "fracture" or "trauma" were excluded from the analyses.
During the follow-up period, 122 women died, and 1676 women were hospitalized on at least one occasion for reasons not related solely to fracture. Compared with women without prevalent vertebral deformities, those women with prevalent deformities had higher risks of mortality (age- and treatment assignment-adjusted relative risk 1.60, 95% confidence interval (CI), 1.10-2.32) and hospitalization (age- and treatment assignment-adjusted relative risk 1.18, 95% CI, 1.06-1.31). In addition, further adjustment for other factors, including smoking status, physical activity, hypertension, coronary heart disease, obstructive lung disease, any fracture since the age of 50, health status, total hip BMD, and body mass index did not alter the association between prevalent vertebral deformities and risk of mortality substantially (multivariate relative risk 1.49, 95% CI, 1.05-2.21). Adjustment for all these factors and diabetes also did not change the relationship between prevalent vertebral deformities and hospitalization (multivariate relative risk 1.14, 95% CI, 1.02-1.27). Rates of mortality and hospitalization increased with increasing number of prevalent vertebral deformities (tests for trend P < .01).
Prevalent vertebral deformities in older women with low bone mass are associated with increased risks of mortality and hospitalization. Only a portion of this increased risk was explained by other known predictors of these outcomes.
确定低骨量老年女性中现患椎体畸形与死亡率及住院风险之间的关系。
一项前瞻性队列研究。
美国的11个临床中心。
共有6459名年龄在55至81岁之间的社区居住低骨量女性参与了骨折干预试验（FIT），这是一项关于阿仑膦酸钠的多中心临床试验，该试验仅根据是否存在现有的影像学椎体畸形将女性纳入两个研究组之一。FIT椎体骨折组纳入了2027名至少有一处椎体畸形的女性，并对其进行了平均2.9年的前瞻性随访，而FIT临床骨折组纳入了4432名无椎体畸形的女性，并对其进行了平均4.2年的前瞻性随访。
在协调中心通过数字化的影像学形态测量和半定量放射学解释相结合的方法，对基线时胸部和腰椎侧位X线片上的现患椎体畸形进行判定。通过获取所有死亡参与者的原始死亡证明副本确认死亡情况。通过不良事件报告获取住院情况；分析中排除仅由包含“骨折”或“创伤”字样的不良事件导致的住院。
在随访期间，122名女性死亡，1676名女性因并非仅与骨折相关的原因至少住院一次。与无现患椎体畸形的女性相比，有现患畸形的女性死亡风险更高（年龄和治疗分组调整后的相对风险为1.60，95%置信区间（CI）为1.10 - 2.32），住院风险也更高（年龄和治疗分组调整后的相对风险为1.18，95%CI为1.06 - 1.31）。此外，对其他因素进行进一步调整，包括吸烟状况、身体活动、高血压、冠心病、阻塞性肺病、50岁以后的任何骨折、健康状况、全髋骨密度和体重指数，并未显著改变现患椎体畸形与死亡风险之间的关联（多变量相对风险为1.49，95%CI为1.05 - 2.21）。对所有这些因素以及糖尿病进行调整也未改变现患椎体畸形与住院之间的关系（多变量相对风险为1.14，95%CI为1.02 - 1.27）。死亡率和住院率随着现患椎体畸形数量的增加而上升（趋势检验P <.01）。
低骨量老年女性中的现患椎体畸形与死亡率及住院风险增加相关。这些增加的风险中只有一部分可由这些结局的其他已知预测因素解释。
