Nguyen Tuan V, Center Jacqueline R, Eisman John A
Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia.
J Bone Miner Res. 2005 Jul;20(7):1195-201. doi: 10.1359/JBMR.050215. Epub 2005 Feb 21.
Whereas low BMD is known to be a risk factor for fracture, it is not clear whether loss of BMD is also a risk factor. In elderly women, greater loss of BMD at the femoral neck was associated with increased risk of fracture, independent of baseline BMD and age.
Baseline measurement of BMD predicts fracture risk. However, it is not clear whether short-term bone loss is an independent risk factor for fractures. This study was designed to investigate the relationship between changes in BMD and fracture risk in elderly women in the general population.
A total of 966 women > or = 60 years of age (mean, 70 +/- 6.7 [SD] years), who had been followed for an average of 10.7 years, were studied. Atraumatic fracture of the proximal femur (hip), symptomatic vertebral fracture, and other major fractures, excluding pathological fractures or those resulting from severe trauma, were recorded and confirmed by radiographs. Femoral neck and lumbar spine BMD was measured by DXA.
During the follow-up period, 224 had sustained a fracture (including 43 hip, 71 symptomatic vertebrae, 37 proximal humerus, 46 forearm and wrist, and 27 rib and pelvis fractures). The annual rate of change in BMD in fracture women (-2.1 +/- 4.2%) was significantly higher than that in nonfracture women (-0.8 +/- 2.8%; p = 0.005). In the multivariable Cox's proportional hazards analysis, the following factors were significant predictors of fracture risk: femoral neck bone loss (relative hazard [RH], 1.4; 95% CI, 1.1-1.8 per 5% loss), baseline femoral neck BMD (RH, 2.0; 95% CI, 1.7-2.7 per SD), and advancing age (RH, 1.2; 95% CI, 1.1-1.4). The proportion of fractures attributable to the three factors was 45%. For hip fracture, the attributable risk fraction was approximately 90%.
Bone loss at the femoral neck is a predictor of fracture risk in elderly women, independent of baseline BMD and age.
虽然已知低骨密度是骨折的一个危险因素，但骨密度降低是否也是一个危险因素尚不清楚。在老年女性中，股骨颈骨密度的更大降低与骨折风险增加相关，与基线骨密度和年龄无关。
骨密度的基线测量可预测骨折风险。然而，短期骨质流失是否是骨折的独立危险因素尚不清楚。本研究旨在调查一般人群中老年女性骨密度变化与骨折风险之间的关系。
共研究了966名年龄≥60岁（平均70±6.7[标准差]岁）的女性，她们平均随访了10.7年。记录并通过X线片确认了股骨近端（髋部）的无创伤性骨折、有症状的椎体骨折以及其他主要骨折，排除病理性骨折或严重创伤导致的骨折。通过双能X线吸收法测量股骨颈和腰椎的骨密度。
在随访期间，224人发生了骨折（包括43例髋部骨折、71例有症状的椎体骨折、37例肱骨近端骨折、46例前臂和腕部骨折以及27例肋骨和骨盆骨折）。骨折女性的骨密度年变化率（-2.1±4.2%）显著高于未骨折女性（-0.8±2.8%；p=0.005）。在多变量Cox比例风险分析中，以下因素是骨折风险的显著预测因素：股骨颈骨质流失（相对风险[RH]，1.4；每5%流失的95%可信区间，1.1-1.8）、基线股骨颈骨密度（RH，2.0；每标准差的95%可信区间，1.7-2.7）和年龄增长（RH，1.2；95%可信区间，1.1-1.4）。这三个因素导致的骨折比例为45%。对于髋部骨折，归因风险分数约为90%。
股骨颈骨质流失是老年女性骨折风险的一个预测因素，与基线骨密度和年龄无关。
