Johnell O, Oden A, Caulin F, Kanis J A
Department of Orthopaedics, Malmö General Hospital, Malmö, Sweden.
Osteoporos Int. 2001;12(3):207-14. doi: 10.1007/s001980170131.
The aims of this study were to determine the magnitude of the increase in risk of further fracture following hospitalization for vertebral fracture, and in particular to determine the time course of this risk. The records of the Swedish Patient Register were examined from 1987 to 1994 to identify all patients who were admitted to hospital for thoracic or lumbar vertebral fractures. Vertebral fractures were characterized as due to high- or low-energy trauma. Patients were followed for subsequent hospitalizations for hip fracture, and for all fractures combined. A Poisson model was used to determine the absolute risk of subsequent nonvertebral fracture and compared with that of the general population. We analyzed 13.4 million hospital admissions from which 28,869 individuals with vertebral fracture were identified, of which 60% were associated with low-energy trauma. There was a marked increase in subsequent incidence of hip and all fractures within the first year following hospitalization for vertebral fracture in both men and women. Thereafter, fracture incidence declined toward, but did not attain, baseline risk. Increased risks were particularly marked in the young. The increase in fracture risk was more marked following low-energy vertebral fracture than in the case of high-energy trauma. We conclude that the high incidence of new fractures within a year of hospitalization for vertebral fractures, irrespective of the degree of trauma involved, indicates that such patients should be preferentially targeted for treatment. It is speculated that short courses of treatment at the time of first vertebral fracture could provide important therapeutic dividends.
本研究的目的是确定因椎体骨折住院后再次骨折风险增加的程度，尤其是确定这种风险随时间的变化情况。对瑞典患者登记处1987年至1994年的记录进行了检查，以识别所有因胸腰椎椎体骨折入院的患者。椎体骨折被分为高能量或低能量创伤所致。对患者进行随访，观察其随后因髋部骨折及所有骨折合并情况而再次住院的情况。使用泊松模型确定随后非椎体骨折的绝对风险，并与一般人群的风险进行比较。我们分析了1340万例住院病例，从中识别出28869例椎体骨折患者，其中60%与低能量创伤有关。在因椎体骨折住院后的第一年，男性和女性髋部骨折及所有骨折的后续发病率均显著增加。此后，骨折发病率下降至基线风险水平，但未达到基线风险。骨折风险增加在年轻人中尤为明显。低能量椎体骨折后骨折风险的增加比高能量创伤更为显著。我们得出结论，椎体骨折住院一年内新骨折的高发病率，无论涉及的创伤程度如何，都表明此类患者应优先接受治疗。据推测，首次椎体骨折时的短期治疗可能会带来重要的治疗效果。
