Lee Sun H, Dargent-Molina Patricia, Bréart Gérard
INSERM, Unité 149, Villejuif, France.
J Bone Miner Res. 2002 May;17(5):817-25. doi: 10.1359/jbmr.2002.17.5.817.
Fracture of the proximal humerus is one of the most frequent fractures attributable to osteoporosis; yet, it has seldom been studied. Two types of factors (related to bone fragility and falls) were evaluated to identify risk factors for proximal humerus fractures as well as to examine possible interactions between them. Subjects were 6901 white women aged > or =75 years and all participated in the EPIDOS study of risk factors for osteoporotic fractures (France, 1992-1998). The baseline examination included measurements of femoral neck bone mineral density (BMD) and calcaneal ultrasound parameters (speed of sound [SOS] and broadband ultrasound attenuation [BUA]), a functional clinical examination, and completing a questionnaire on health status and lifestyle. During a mean of 3.6 (0.8) years of follow-up, 165 women had a humeral fracture. Using multivariate Cox regression models, we identified three predictors related to bone fragility-low BMD (relative risk [RR] = 1.4; 95% CI, 1.1-1.7), low SOS (RR = 1.3; 95% CI, 1.0-1.6), and maternal history of hip fracture (RR = 1.8; 95% CI, 1.0-3.0)-and four fall-related predictors-a previous fall (RR = 3.0; 95% CI, 1.5-6.1), a low level of physical activity (RR = 2.2; 95% CI, 1.1-4.4), impaired balance (RR = 1.8; 95% CI, 1.1-2.9), and pain in lower limb extremity (RR = 1.4; 95% CI, 1.0-2.1). The effect of these fall-related predictors varied according to the BMD level; they were significantly associated with proximal humerus fractures in women with osteoporosis (BMD T score < -2.5) but not in nonosteoporotic women. The incidence of proximal humerus fracture in women with osteoporosis and a low fall risk score (5.1 per 1000 woman-years) was only slightly higher than in nonosteoporotic women (4.6 per 1000 woman-years) and similar to the incidence in women without osteoporosis but a high fall risk score (5.3 per 1000 woman-years). On the other hand, the incidence in women who had both types of risk factors was more than two times higher (12.1 per 1000 woman-years) than in women with only one of the two risk factors. These results suggest that women who have both types of risk factors should receive the highest priority for prevention.
肱骨近端骨折是骨质疏松所致最常见的骨折之一；然而，对其研究甚少。我们评估了两类因素（与骨脆性和跌倒相关），以确定肱骨近端骨折的危险因素，并研究它们之间可能的相互作用。研究对象为6901名年龄≥75岁的白人女性，她们均参与了骨质疏松性骨折危险因素的EPIDOS研究（法国，1992 - 1998年）。基线检查包括测量股骨颈骨密度（BMD）和跟骨超声参数（声速[SOS]和宽带超声衰减[BUA]）、进行功能性临床检查以及填写一份关于健康状况和生活方式的问卷。在平均3.6（0.8）年的随访期间，165名女性发生了肱骨骨折。使用多变量Cox回归模型，我们确定了三个与骨脆性相关的预测因素——低骨密度（相对风险[RR]=1.4；95%可信区间，1.1 - 1.7）、低声速（RR = 1.3；95%可信区间，1.0 - 1.6）和母亲有髋部骨折病史（RR = 1.8；95%可信区间，1.0 - 3.0），以及四个与跌倒相关的预测因素——既往跌倒史（RR = 3.0；95%可信区间，1.5 - 6.1）、低体力活动水平（RR = 2.2；95%可信区间，1.1 - 4.4）、平衡功能受损（RR = 1.8；95%可信区间，1.1 - 2.9）和下肢疼痛（RR = 1.4；95%可信区间，1.0 - 2.1）。这些与跌倒相关的预测因素的作用因骨密度水平而异；它们在骨质疏松女性（骨密度T值< - 2.5）中与肱骨近端骨折显著相关，但在非骨质疏松女性中并非如此。骨质疏松且跌倒风险评分低的女性中肱骨近端骨折的发生率（每1000女性 - 年5.1例）仅略高于非骨质疏松女性（每1000女性 - 年4.6例），且与无骨质疏松但跌倒风险评分高的女性发生率（每1000女性 - 年5.3例）相似。另一方面，具有两类危险因素的女性的发生率比仅具有两类危险因素之一的女性高出两倍多（每1000女性 - 年12.1例）。这些结果表明，具有两类危险因素的女性应成为预防的首要重点对象。
