Goulding A, Jones I E, Taylor R W, Manning P J, Williams S M
Department of Medical and Surgical Sciences, Otago University, Dunedin, New Zealand.
J Bone Miner Res. 2000 Oct;15(10):2011-8. doi: 10.1359/jbmr.2000.15.10.2011.
Predictors of childhood fractures have not been investigated previously. This study was undertaken to determine whether a previous history of forearm fracture, low bone mineral density (BMD; both areal bone mineral density [aBMD, g/cm2] and volumetric bone mineral apparent density [BMAD, g/cm3]), or anthropometry, influence fracture risk in young girls. At baseline, two cohorts of girls, aged 3-15 years, were evaluated: 100 had recently broken a forearm (group 1) and 100 were fracture free (group 2). Four years later we restudied 170 of these girls (82 from group 1 and 88 from group 2). We now report the relationships of previous fracture history, baseline BMD (measured by dual-energy X-ray absorptiometry), baseline weight, and height to risk of new fracture. More new fractures occurred in group 1 (37 fractures in 24 girls) than in group 2 (8 fractures in 7 girls; p = 0.0007). The independent predictors for occurrence of a new fracture at any skeletal site in a multivariate model adjusting for age, weight, total body aBMD, and fracture history were previous fracture (hazard ratio [HR], 3.28; 95% CI, 1.41-7.64); age (HR per 1-year increase, 0.91; 95% CI, 0.84-0.99); total body aBMD (HR per 1 SD decrease, 1.92; 95% CI, 1.31-2.81); and body weight (HR per 1 SD increase, 1.49; 95% CI, 1.06-2.08). Girls with two risk factors together had substantially greater fracture risk: previous fracture and low spinal BMAD (HR, 9.4; 95% CI, 2.8-32.0), previous fracture and high body weight (HR, 10.2; 95% CI, 2.8-37.6), or previous fracture and low total body aBMD (HR, 13.0; 95% CI, 3.9-43.1). We conclude that previous forearm fracture, low total body aBMD, low spinal BMAD, and high body weight each increase risk of new fractures within 4 years in young girls. Interventions to reduce the risk of fractures, particularly forearm fractures, in girls warrant further study.
此前尚未对儿童骨折的预测因素进行过研究。本研究旨在确定既往前臂骨折史、低骨矿物质密度（BMD；包括面积骨矿物质密度[aBMD，g/cm²]和体积骨矿物质表观密度[BMAD，g/cm³]）或人体测量学指标是否会影响年轻女孩的骨折风险。在基线时，对两组3至15岁的女孩进行了评估：100名近期有前臂骨折（第1组），100名无骨折（第2组）。四年后，我们对其中170名女孩进行了再次研究（第1组82名，第2组88名）。我们现在报告既往骨折史、基线BMD（通过双能X线吸收法测量）、基线体重和身高与新发骨折风险之间的关系。第1组发生的新发骨折（24名女孩中有37处骨折）比第2组（7名女孩中有8处骨折；p = 0.0007）更多。在对年龄、体重、全身aBMD和骨折史进行校正的多变量模型中，任何骨骼部位发生新发骨折的独立预测因素为既往骨折（风险比[HR]，3.28；95%置信区间[CI]，1.41 - 7.64）；年龄（每增加1岁的HR，0.91；95% CI，0.84 - 0.99）；全身aBMD（每降低1个标准差的HR，1.92；95% CI，1.31 - 2.81）；以及体重（每增加1个标准差的HR，1.49；95% CI，1.06 - 2.08）。具有两种危险因素的女孩骨折风险显著更高：既往骨折和低脊柱BMAD（HR，9.4；95% CI，2.8 - 32.0）、既往骨折和高体重（HR，10.2；95% CI，2.8 - 37.6）或既往骨折和低全身aBMD（HR，13.0；95% CI，3.9 - 43.1）。我们得出结论，既往前臂骨折、低全身aBMD、低脊柱BMAD和高体重均会增加年轻女孩在4年内发生新发骨折的风险。降低女孩骨折风险，尤其是前臂骨折风险的干预措施值得进一步研究。
