Johnell Olof, Kanis John A, Oden Anders, Johansson Helena, De Laet Chris, Delmas Pierre, Eisman John A, Fujiwara Seiko, Kroger Heikki, Mellstrom Dan, Meunier Pierre J, Melton L Joseph, O'Neill Terry, Pols Huibert, Reeve Jonathan, Silman Alan, Tenenhouse Alan
Department of Orthopaedics, Malmo University Hospital, Malmo, Sweden.
J Bone Miner Res. 2005 Jul;20(7):1185-94. doi: 10.1359/JBMR.050304. Epub 2005 Mar 7.
The relationship between BMD and fracture risk was estimated in a meta-analysis of data from 12 cohort studies of approximately 39,000 men and women. Low hip BMD was an important predictor of fracture risk. The prediction of hip fracture with hip BMD also depended on age and z score.
The aim of this study was to quantify the relationship between BMD and fracture risk and examine the effect of age, sex, time since measurement, and initial BMD value.
We studied 9891 men and 29,082 women from 12 cohorts comprising EVOS/EPOS, EPIDOS, OFELY, CaMos, Rochester, Sheffield, Rotterdam, Kuopio, DOES, Hiroshima, and 2 cohorts from Gothenburg. Cohorts were followed for up to 16.3 years and a total of 168,366 person-years. The effect of BMD on fracture risk was examined using a Poisson model in each cohort and each sex separately. Results of the different studies were then merged using weighted coefficients.
BMD measurement at the femoral neck with DXA was a strong predictor of hip fractures both in men and women with a similar predictive ability. At the age of 65 years, risk ratio increased by 2.94 (95% CI = 2.02-4.27) in men and by 2.88 (95% CI = 2.31-3.59) in women for each SD decrease in BMD. However, the effect was dependent on age, with a significantly higher gradient of risk at age 50 years than at age 80 years. Although the gradient of hip fracture risk decreased with age, the absolute risk still rose markedly with age. For any fracture and for any osteoporotic fracture, the gradient of risk was lower than for hip fractures. At the age of 65 years, the risk of osteoporotic fractures increased in men by 1.41 per SD decrease in BMD (95% CI = 1.33-1.51) and in women by 1.38 per SD (95% CI = 1.28-1.48). In contrast with hip fracture risk, the gradient of risk increased with age. For the prediction of any osteoporotic fracture (and any fracture), there was a higher gradient of risk the lower the BMD. At a z score of -4 SD, the risk gradient was 2.10 per SD (95% CI = 1.63-2.71) and at a z score of -1 SD, the risk was 1.73 per SD (95% CI = 1.59-1.89) in men and women combined. A similar but less pronounced and nonsignificant effect was observed for hip fractures. Data for ultrasound and peripheral measurements were available from three cohorts. The predictive ability of these devices was somewhat less than that of DXA measurements at the femoral neck by age, sex, and BMD value.
We conclude that BMD is a risk factor for fracture of substantial importance and is similar in both sexes. Its validation on an international basis permits its use in case finding strategies. Its use should, however, take account of the variations in predictive value with age and BMD.
在一项对约39000名男性和女性的12项队列研究数据进行的荟萃分析中，估算了骨密度（BMD）与骨折风险之间的关系。低髋部骨密度是骨折风险的重要预测指标。用髋部骨密度预测髋部骨折还取决于年龄和z值。
本研究的目的是量化骨密度与骨折风险之间的关系，并研究年龄、性别、测量后时间以及初始骨密度值的影响。
我们研究了来自12个队列（包括EVOS/EPOS、EPIDOS、OFELY、CaMos、罗切斯特、谢菲尔德、鹿特丹、库奥皮奥、DOES、广岛以及哥德堡的2个队列）的9891名男性和29082名女性。对这些队列随访长达16.3年，总计168366人年。在每个队列和每种性别中分别使用泊松模型研究骨密度对骨折风险的影响。然后使用加权系数合并不同研究的结果。
使用双能X线吸收法（DXA）测量股骨颈骨密度，对男性和女性髋部骨折都是一个强有力的预测指标，且预测能力相似。在65岁时，男性骨密度每降低1个标准差（SD），风险比增加2.94（95%置信区间[CI]=2.02 - 4.27），女性增加2.88（95%CI = 2.31 - 3.59）。然而，这种影响取决于年龄，50岁时的风险梯度显著高于80岁时。虽然髋部骨折风险梯度随年龄降低，但绝对风险仍随年龄显著上升。对于任何骨折和任何骨质疏松性骨折，风险梯度低于髋部骨折。在65岁时，男性骨密度每降低1个标准差，骨质疏松性骨折风险增加1.41（95%CI = 1.33 - 1.51），女性增加1.38（95%CI = 1.28 -
