Colón-Emeric Cathleen, Kuchibhatla Maragatha, Pieper Carl, Hawkes William, Fredman Lisa, Magaziner Jay, Zimmerman Sheryl, Lyles Kenneth W
Center for the Study of Aging and Human Development, Department of Biometry and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA.
Osteoporos Int. 2003 Nov;14(11):879-83. doi: 10.1007/s00198-003-1460-x. Epub 2003 Oct 3.
The contribution of hip fracture to the risk of subsequent fractures is unclear.
Data from the Baltimore Hip Studies and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used. Baltimore subjects enrolled at the time of hip fracture ( n=549) and EPESE subjects without previous fractures at baseline ( n=10,680) were followed for 2-10 years. Self-reported nonhip skeletal fracture was the outcome, and hip fracture was a time-varying covariate in a survival analysis stratified by study site. The model was adjusted for race, sex, age, BMI, stroke, cancer, difficulty walking across a room, dependence in grooming, dependence in transferring, and cognitive impairment.
The rate of all subsequent self-reported fractures after hip fracture was 10.4 fractures/100 person-years. The unadjusted hazard of nonhip skeletal fracture was 2.52 (95% confidence interval 2.05 to 3.12) for subjects with hip fracture compared with subjects without; when adjusted for other known fracture risk factors the hazard ratio was 1.62 (1.30 to 2.02). Men and women had a similar relative risk increase. The increased risk of secondary fracture after hip fracture persisted over time.
A hip fracture is associated with a 2.5-fold increased risk of subsequent fracture, which is not entirely explained by prefracture risk factors. Careful attention to secondary prevention is warranted in these patients.
髋部骨折对后续骨折风险的影响尚不清楚。
使用了来自巴尔的摩髋部研究和老年人流行病学研究既定人群（EPESE）的数据。对髋部骨折时纳入的巴尔的摩受试者（n = 549）和基线时无既往骨折的EPESE受试者（n = 10,680）进行了2至10年的随访。自我报告的非髋部骨骼骨折为研究结果，在按研究地点分层的生存分析中，髋部骨折是一个随时间变化的协变量。该模型针对种族、性别、年龄、体重指数、中风、癌症、穿过房间的行走困难、修饰依赖、转移依赖和认知障碍进行了调整。
髋部骨折后所有后续自我报告骨折的发生率为10.4例骨折/100人年。与无髋部骨折的受试者相比，有髋部骨折的受试者未调整的非髋部骨骼骨折风险为2.52（95%置信区间2.05至3.12）；在调整其他已知骨折风险因素后，风险比为1.62（1.30至2.02）。男性和女性的相对风险增加相似。髋部骨折后二次骨折的风险增加随时间持续存在。
髋部骨折与后续骨折风险增加2.5倍相关，骨折前风险因素不能完全解释这一现象。对这些患者应谨慎关注二级预防。
