Schousboe John T, Fink Howard A, Taylor Brent C, Stone Katie L, Hillier Teresa A, Nevitt Michael C, Ensrud Kristine E
Section of Rheumatology, Park Nicollet Health Services, Minneapolis, Minnesota 55416, USA.
J Bone Miner Res. 2005 Jan;20(1):100-6. doi: 10.1359/JBMR.041025. Epub 2004 Oct 25.
In this large prospective cohort study of elderly women, the relationships between prior wrist fracture and incident hip and radiographic vertebral fractures were significantly attenuated when adjusted for BMD. This study suggests that BMD thresholds for drug therapy to prevent osteoporotic fracture should be only modestly adjusted in those with prior wrist fracture compared with those without prior wrist fracture. Validation of such an approach would require intervention trials in patients with prior wrist fracture.
Prior wrist fracture has been identified as a risk factor for incident hip and vertebral fractures and proposed as a criterion for determining who should be offered drug therapy to prevent osteoporotic fracture, even if their hip BMD T score is > -2.5. Previously published studies of the relationships between prior wrist fracture and incident hip and vertebral fractures did not adjust for BMD.
We ascertained prior history of wrist fracture since age 50, measured calcaneal and hip BMD, and performed lateral spine films in a cohort of 9704 elderly community-dwelling women, and then followed them prospectively for incident vertebral and hip fractures. Incident vertebral fractures were defined by morphometry using lateral spine radiography at the first examination and an average of 3.7 years later. Incident hip fractures were confirmed with radiographic reports over a mean follow-up period of 10.1 years.
Prior wrist fracture was associated with an age-adjusted 72% increased odds of incident radiographic vertebral fracture (odds ratio [OR], 1.72; 95% CI, 1.31-2.25). After adjustment for calcaneal BMD, the association of prior wrist fracture with incident radiographic vertebral fracture was attenuated (OR, 1.39; 95% CI, 1.05-1.83). Prior wrist fracture was also associated with an age-adjusted 43% excess rate of incident hip fracture (hazards ratio [HR], 1.43; 95% CI, 1.17-1.74). After adjustment for hip BMD, the association of prior wrist fracture with rate of incident hip fracture was no longer statistically significant (HR, 1.12; 95% CI, 0.92-1.38).
In elderly women, prior wrist fracture is a risk factor for radiographic vertebral fracture independent of BMD. The association between prior wrist fracture and incident hip fracture is largely explained by hip BMD. Modest adjustment of BMD drug treatment thresholds for prevention of osteoporotic fractures in those with prior wrist fracture compared with those without prior wrist fracture may be reasonable, but validation of such an approach would require intervention trials in patients with prior wrist fracture.
在这项针对老年女性的大型前瞻性队列研究中，在校正骨密度（BMD）后，既往腕部骨折与髋部骨折及椎体影像学骨折之间的关系显著减弱。本研究表明，与无既往腕部骨折者相比，对于有既往腕部骨折者，预防骨质疏松性骨折的药物治疗骨密度阈值应仅进行适度调整。验证这种方法需要对有既往腕部骨折的患者进行干预试验。
既往腕部骨折已被确定为髋部和椎体骨折的危险因素，并被提议作为确定哪些人应接受药物治疗以预防骨质疏松性骨折的标准，即使其髋部骨密度T值＞ -2.5。先前发表的关于既往腕部骨折与髋部及椎体骨折关系的研究未对骨密度进行校正。
我们确定了9704名社区居住老年女性自50岁起的腕部骨折既往史，测量了跟骨和髋部骨密度，并拍摄了脊柱侧位片，然后对她们进行前瞻性随访以观察椎体和髋部骨折的发生情况。首次检查时及平均3.7年后通过脊柱侧位X线摄影测量形态学指标来定义椎体骨折的发生。通过影像学报告确认髋部骨折的发生情况，平均随访期为10.1年。
在校正年龄后，既往腕部骨折与椎体影像学骨折发生风险增加72%相关（比值比[OR]，1.72；95%置信区间[CI]，1.31 - 2.25）。在校正跟骨骨密度后，既往腕部骨折与椎体影像学骨折的关联减弱（OR，1.39；95% CI，1.05 - 1.83）。既往腕部骨折还与在校正年龄后髋部骨折发生率高出43%相关（风险比[HR]，1.43；95% CI，1.17 - 1.74）。在校正髋部骨密度后，既往腕部骨折与髋部骨折发生率之间的关联不再具有统计学意义（HR，1.12；95% CI，0.92 - 1.38）。
在老年女性中，既往腕部骨折是独立于骨密度的椎体影像学骨折的危险因素。既往腕部骨折与髋部骨折发生之间的关联在很大程度上可由髋部骨密度解释。与无既往腕部骨折者相比，对有既往腕部骨折者预防骨质疏松性骨折的骨密度药物治疗阈值进行适度调整可能是合理的，但验证这种方法需要对有既往腕部骨折的患者进行干预试验。
