Papaioannou Alexandra, Joseph Lawrence, Ioannidis George, Berger Claudie, Anastassiades Tassos, Brown Jacques P, Hanley David A, Hopman Wilma, Josse Robert G, Kirkland Susan, Murray Timothy M, Olszynski Wojciech P, Pickard Laura, Prior Jerilynn C, Siminoski Kerry, Adachi Jonathan D
Department of Medicine, St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
Osteoporos Int. 2005 May;16(5):568-78. doi: 10.1007/s00198-004-1735-x. Epub 2004 Oct 27.
Utilizing data from the Canadian Multicentre Osteoporosis Study (CaMos), we examined the association between potential risk factors and incident vertebral and nonvertebral fractures. A total of 5,143 postmenopausal women were enrolled. Information collected during the study included data from the CaMos baseline and annually mailed fracture questionnaires, the Short Form 36 (SF-36), the Health Utilities Index, and physical measurements. Participants were followed for 3 years. Postmenopausal women were classified into four groups according to their incident fracture status since baseline: those without a new fracture; those with a new clinically recognized vertebral fracture; those with an incident nonvertebral fracture at the wrist, hip, humerus, pelvis, or ribs (main nonvertebral fracture group); and those with any new nonvertebral fracture (any-nonvertebral-fracture group). We performed multivariate Cox proportional hazard analysis using all possible risk factors to determine the association between risk factors and the time to the first minimal trauma fracture. Best predictive models were also determined using variables that were included in the full models. The Bayesian information criterion was used for model selection. For all analyses, relative risks and associated 95% confidence intervals were calculated. During the follow-up period, 34, 163, and 280 women developed a vertebral, a main nonvertebral, or any nonvertebral fracture, respectively. The best predictive models indicated that a five point lower quality of life as measured by the SF-36 physical component summary score was associated with relative risks of 1.21 (95% CI, 1.02 to 1.44), 1.17 (95% CI, 1.07 to 1.28), and 1.19 (95% CI, 1.11 to 1.27) for incident vertebral, main nonvertebral, and all nonvertebral fractures, respectively. In addition, for a one standard deviation (SD=0.12) lower femoral neck BMD, the relative risks for incident vertebral, main nonvertebral, and any nonvertebral fractures increased by 2.73 (95% CI, 1.74 to 4.28), 1.39 (95% CI, 1.06 to 1.82), and 1.34 (95% CI, 1.09 to 1.65), respectively. Furthermore, various anthropometric measures, disease conditions, and medications are associated with a new fracture. Identifying postmenopausal women at risk is important given that fracture prevention therapies are now available.
利用加拿大多中心骨质疏松症研究（CaMos）的数据，我们研究了潜在风险因素与新发椎体骨折和非椎体骨折之间的关联。总共招募了5143名绝经后女性。研究期间收集的信息包括CaMos基线数据以及每年邮寄的骨折调查问卷、简短健康调查问卷36项版本（SF - 36）、健康效用指数和身体测量数据。对参与者进行了3年的随访。绝经后女性根据自基线以来的新发骨折状况分为四组：无新发骨折者；有新的临床确诊椎体骨折者；有手腕、髋部、肱骨、骨盆或肋骨部位的新发非椎体骨折者（主要非椎体骨折组）；以及有任何新发非椎体骨折者（任何非椎体骨折组）。我们使用所有可能的风险因素进行多变量Cox比例风险分析，以确定风险因素与首次轻微创伤骨折发生时间之间的关联。还使用完整模型中包含的变量确定了最佳预测模型。采用贝叶斯信息准则进行模型选择。对于所有分析，计算了相对风险及相关的95%置信区间。在随访期间，分别有34名、163名和280名女性发生了椎体骨折、主要非椎体骨折或任何非椎体骨折。最佳预测模型表明，以SF - 36身体成分汇总评分衡量，生活质量降低5分与新发椎体骨折、主要非椎体骨折和所有非椎体骨折的相对风险分别为1.21（95%置信区间，1.02至1.44）、1.17（95%置信区间，1.07至1.28）和1.19（95%置信区间，1.11至1.27）相关。此外，股骨颈骨密度每降低一个标准差（SD = 0.12），新发椎体骨折、主要非椎体骨折和任何非椎体骨折的相对风险分别增加2.73（95%置信区间，1.74至4.28）、1.39（95%置信区间，1.06至1.82）和1.34（95%置信区间，1.09至1.65）。此外，各种人体测量指标、疾病状况和药物与新发骨折有关。鉴于现在已有骨折预防疗法，识别有风险的绝经后女性很重要。
