Melton L Joseph, Patel Ashok, Achenbach Sara J, Oberg Ann L, Yunginger John W
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
J Bone Miner Res. 2005 Apr;20(4):564-70. doi: 10.1359/JBMR.041218. Epub 2004 Dec 13.
Fracture risk among patients diagnosed with asthma in childhood is greater in males and oral corticosteroid users, but most fractures are of the appendicular skeleton and may relate to impaired skeletal development.
There are no population-based data on fracture outcomes among the growing number of patients with asthma diagnosed in childhood.
We conducted a population-based retrospective (historical) cohort study among 279 Rochester, Minnesota, residents who were <35 years of age (mean, 6.2 years) when first diagnosed with asthma. Fractures were ascertained by review of comprehensive community medical records, and cases were compared directly with age- and sex-matched controls in a stratified proportional hazards model. Risk factors for fractures among the asthma cases were assessed using Andersen-Gill time-to-fracture regression models.
During 6649 person-years of follow-up (median, 24.3 years/subject), 107 asthma patients experienced 189 fractures, for a crude fracture incidence rate of 2.8 per 100 person-years. The actuarially estimated cumulative fracture incidence after 20 years was 40% compared with 34% among controls (p = 0.122). There was no significant increase in overall fracture risk among cases compared to their age- and sex-matched controls (hazard ratio [HR], 1.3; 95% CI, 0.9-1.9), but males with asthma had a 2.6-fold greater risk of hand and finger fractures than control males. The independent predictors of overall fracture risk among the asthma patients included male gender (HR, 2.2; 95% CI, 1.5-3.2) and use of oral corticosteroids (HR, 2.0; 95% CI, 1.2-3.1) or anti-cholinergic agents (HR, 3.9; 95% CI, 1.5-10).
Rather than osteoporotic fractures of the axial skeleton, oral corticosteroid therapy was associated here with limb fractures, suggesting a relationship with impaired development of a biomechanically competent skeleton. Additional studies are needed to assess this possibility.
儿童期被诊断为哮喘的患者中，男性及口服皮质类固醇使用者的骨折风险更高，但大多数骨折发生在四肢骨骼，可能与骨骼发育受损有关。
在越来越多儿童期被诊断为哮喘的患者中，尚无基于人群的骨折结局数据。
我们对明尼苏达州罗切斯特市279名居民进行了一项基于人群的回顾性（历史性）队列研究，这些居民首次被诊断为哮喘时年龄小于35岁（平均6.2岁）。通过查阅综合社区医疗记录确定骨折情况，并在分层比例风险模型中将病例与年龄和性别匹配的对照直接进行比较。使用安德森-吉尔骨折时间回归模型评估哮喘病例中骨折的危险因素。
在6649人年的随访期间（中位数，每位受试者24.3年），107名哮喘患者发生了189次骨折，粗骨折发病率为每100人年2.8次。20年后经精算估计的累积骨折发病率为40%，而对照组为34%（p = 0.122）。与年龄和性别匹配的对照相比，病例的总体骨折风险没有显著增加（风险比[HR]，1.3；95%置信区间，0.9 - 1.9），但哮喘男性手部和手指骨折的风险是对照男性的2.6倍。哮喘患者总体骨折风险的独立预测因素包括男性（HR，2.2；95%置信区间，1.5 - 3.2）、口服皮质类固醇的使用（HR，2.0；95%置信区间，1.2 - 3.1）或抗胆碱能药物的使用（HR，3.9；95%置信区间，1.5 - 10）。
口服皮质类固醇治疗在此处与四肢骨折相关，而非轴向骨骼骨质疏松性骨折，提示与生物力学功能正常的骨骼发育受损有关。需要进一步研究来评估这种可能性。
