Melton L J, Achenbach S J, O'fallon W M, Khosla S
Department of Health Sciences Research, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Bone. 2002 Jul;31(1):119-25. doi: 10.1016/s8756-3282(02)00788-3.
Secondary osteoporosis plays an important role in the pathogenesis of hip and spine fractures, but relatively little is known about the potential impact of secondary osteoporosis and fall-related disorders on the risk of distal forearm fractures. To address this issue, we conducted a population-based, nested case-control study comparing 496 Rochester, Minnesota, residents with an initial distal forearm fracture to an equal number of age- and gender-matched controls. Potential risk factors were assessed by review of each subject's complete (inpatient and outpatient) medical records in the community (median duration >30 years) and analyzed using multiple logistic regression. Although history of diabetes mellitus in women (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.15-0.75) and long-term anticonvulsant use in both genders (OR 3.58, 95% CI 1.26-10) were independently associated with fracture risk in a multivariate analysis, the conditions linked with secondary osteoporosis had, in aggregate, no statistically significant association with distal forearm fractures. Fall-related conditions altogether were associated with a borderline increase in risk (OR 1.36, 95% CI 0.98-1.91) and might have accounted for 19% of forearm fracture occurrence in the community. Among women (OR 2.72, 95% CI 1.20-6.19), but not men, a history of prior osteoporotic fracture was also associated with an increase in distal forearm fractures. These factors do not appear to account for the discrepancy in forearm fracture incidence in women when compared with men.
继发性骨质疏松在髋部和脊柱骨折的发病机制中起重要作用，但对于继发性骨质疏松和跌倒相关疾病对桡骨远端骨折风险的潜在影响，我们知之甚少。为解决这一问题，我们进行了一项基于人群的巢式病例对照研究，将496名明尼苏达州罗切斯特市首次发生桡骨远端骨折的居民与同等数量年龄和性别匹配的对照进行比较。通过查阅社区中每位受试者完整的（住院和门诊）病历（中位病程>30年）评估潜在危险因素，并使用多因素logistic回归进行分析。尽管在多因素分析中，女性糖尿病史（比值比[OR]0.34，95%置信区间[CI]0.15 - 0.75）和两性长期使用抗惊厥药物（OR 3.58，95% CI 1.26 - 10）与骨折风险独立相关，但与继发性骨质疏松相关的疾病总体上与桡骨远端骨折无统计学显著关联。与跌倒相关的疾病总体上与风险的临界增加相关（OR 1.36，95% CI [0.98 - 1.91]），可能占社区中前臂骨折发生率的19%。在女性中（OR 2.72，95% CI 1.20 - 6.19），而非男性，既往骨质疏松性骨折史也与桡骨远端骨折增加相关。与男性相比，这些因素似乎不能解释女性前臂骨折发生率的差异。
