Kanis John A, Johnell Olof, De Laet Chris, Jonsson Bengt, Oden Anders, Ogelsby Alan K
WHO Collaborating Center for Metabolic Bone Diseases, University of Sheffield Medical School, United Kingdom.
J Bone Miner Res. 2002 Jul;17(7):1237-44. doi: 10.1359/jbmr.2002.17.7.1237.
It is recommended that intervention thresholds should be based on absolute fracture risk, but there is a large variation in hip fracture incidence from different regions of the world. The aim of this study was to examine heterogeneity of hip fracture probability in different regions from recent estimates of hip fracture incidence and mortality to adjust intervention thresholds. Ten-year probabilities of hip fracture were computed in men and women at 10-year intervals from the age of 50 years and lifetime risks at the age of 50 years from the hazard functions of hip fracture and death. Lifetime risk at the age of 50 years varied from 1% in women from Turkey to 28.5% in women from Sweden. High lifetime risks in women were associated with high lifetime risks in men (r = 0.83). There also were significant correlations of 10-year risk at any age between men and women. Ten-year probability was standardized to that of men and women from Sweden (set at 1.0). There was a 15-fold range in 10-year probability from 1.24 in Norway to 0.08 in Chile. Countries were categorized by 10-year probabilities comprising very high risk (Norway, Iceland, Sweden, Denmark, and the United States), high risk (China [Taiwan [TW]], Germany, Switzerland, Finland, Greece, Canada, The Netherlands, Hungary, Singapore, Italy, United Kingdom, Kuwait, Australia, and Portugal), medium risk (China [Hong Kong [HK]], France, Japan, Spain, Argentina, and China), and low risk (Turkey, Korea, Venezuela, and Chile). The categorization of hip fracture probabilities can be used to adjust intervention thresholds based on age, sex, and relative risk from a reference population such as Sweden.
建议干预阈值应基于绝对骨折风险，但世界不同地区的髋部骨折发病率差异很大。本研究的目的是根据近期髋部骨折发病率和死亡率的估计值，研究不同地区髋部骨折概率的异质性，以调整干预阈值。根据髋部骨折和死亡的风险函数，计算了50岁及以上男性和女性每隔10年的10年髋部骨折概率以及50岁时的终生风险。50岁时的终生风险在土耳其女性中为1%，在瑞典女性中为28.5%。女性的高终生风险与男性的高终生风险相关（r = 0.83）。男女在任何年龄的10年风险也存在显著相关性。将10年概率标准化为瑞典男性和女性的概率（设定为1.0）。10年概率范围为15倍，从挪威的1.24到智利的0.08。根据10年概率将国家分为极高风险（挪威、冰岛、瑞典、丹麦和美国）、高风险（中国台湾地区、德国、瑞士、芬兰、希腊、加拿大、荷兰、匈牙利、新加坡、意大利、英国、科威特、澳大利亚和葡萄牙）、中等风险（中国香港地区、法国、日本、西班牙、阿根廷和中国大陆）和低风险（土耳其、韩国、委内瑞拉和智利）。髋部骨折概率的分类可用于根据年龄、性别以及来自瑞典等参考人群的相对风险来调整干预阈值。
