Ismail A A, Silman A J, Reeve J, Kaptoge S, O'Neill T W
Department of Rheumatology, Stepping Hill Hospital, Stockport, UK.
Osteoporos Int. 2006 Jan;17(1):41-5. doi: 10.1007/s00198-005-1887-3. Epub 2005 Jun 1.
Population studies suggest that rib fractures are associated with a reduction in bone mass. While much is known about the predictive risk of hip, spine and distal forearm fracture on the risk of future fracture, little is known about the impact of rib fracture. The aim of this study was to determine whether a recalled history of rib fracture was associated with an increased risk of future limb fracture. Men and women aged 50 years and over were recruited from population registers in 31 European centres for participation in a screening survey of osteoporosis (European Prospective Osteoporosis Study). Subjects were invited to complete an interviewer-administered questionnaire that included questions about previous fractures including rib fracture, the age of their first fracture and also the level of trauma. Lateral spine radiographs were performed and the presence of vertebral deformity was determined morphometrically. Following the baseline survey, subjects were followed prospectively by annual postal questionnaire to determine the occurrence of clinical fractures. The subjects included 6,344 men, with a mean age of 64.2 years, and 6,788 women, with a mean age of 63.6 years, who were followed for a median of 3 years (range 0.4-5.9 years), of whom 135 men (2.3%) and 101 women (1.6%) reported a previous low trauma rib fracture. In total, 138 men and 391 women sustained a limb fracture during follow-up. In women, after age adjustment, those with a recalled history of low trauma rib fracture had an increased risk of sustaining 'any' limb fracture [relative hazard (RH)=2.3; 95% CI 1.3, 4.0]. When stratified by fracture type the predictive risk was more marked for hip (RH=7.7; 95% CI 2.3, 25.9) and humerus fracture (RH=4.5; 95% CI 1.4, 14.6) than other sites (RH=1.6; 95% CI 0.6, 4.3). Additional adjustment for prevalent vertebral deformity and previous (non-rib) low trauma fractures at other sites slightly reduced the strength of the association between rib fracture and subsequent limb fracture. In men, after age adjustment, there was a small though non-significant association between recalled history of rib fracture and future limb fracture. Our data highlight the importance of rib fracture as a marker of bone fragility in women.
人群研究表明，肋骨骨折与骨量减少有关。虽然对于髋部、脊柱和前臂远端骨折的预测风险对未来骨折风险的影响已有很多了解，但对于肋骨骨折的影响却知之甚少。本研究的目的是确定回忆起的肋骨骨折病史是否与未来肢体骨折风险增加有关。50岁及以上的男性和女性从31个欧洲中心的人口登记册中招募，参与一项骨质疏松症筛查调查（欧洲前瞻性骨质疏松症研究）。受试者被邀请完成一份由访谈员管理的问卷，其中包括关于既往骨折（包括肋骨骨折）、首次骨折年龄以及创伤程度的问题。进行了脊柱侧位X线摄影，并通过形态计量学确定椎体畸形的存在。在基线调查之后，通过年度邮寄问卷对受试者进行前瞻性随访，以确定临床骨折的发生情况。受试者包括6344名男性，平均年龄64.2岁，以及6788名女性，平均年龄63.6岁，随访中位数为3年（范围0.4 - 5.9年），其中135名男性（2.3%）和101名女性（1.6%）报告有既往低创伤性肋骨骨折。在随访期间，共有138名男性和391名女性发生了肢体骨折。在女性中，年龄调整后，有低创伤性肋骨骨折回忆史的女性发生“任何”肢体骨折的风险增加[相对风险（RH）=2.3；95%置信区间1.3，4.0]。按骨折类型分层时，髋部骨折（RH = 7.7；95%置信区间2.3，25.9）和肱骨骨折（RH = 4.5；95%置信区间1.4，14.6）的预测风险比其他部位（RH = 1.6；95%置信区间0.6，4.3）更显著。对普遍存在的椎体畸形和其他部位既往（非肋骨）低创伤性骨折进行额外调整后，肋骨骨折与随后肢体骨折之间关联的强度略有降低。在男性中，年龄调整后，肋骨骨折回忆史与未来肢体骨折之间存在虽小但无统计学意义的关联。我们的数据突出了肋骨骨折作为女性骨脆性标志物的重要性。
