Olofsson Helena, Byberg Liisa, Mohsen Rawya, Melhus Hakan, Lithell Hans, Michaëlsson Karl
Section of Orthopedics, Department of Surgical Sciences, University Hospital, Uppsala, Sweden.
J Bone Miner Res. 2005 Jul;20(7):1208-15. doi: 10.1359/JBMR.050208. Epub 2005 Feb 14.
The role of smoking on fracture risk in older men was studied within a longitudinal population-based cohort study. Using time-dependent exposure information and analysis, smoking was detected to be a stronger, dose-dependent and a more long lasting risk factor for fracture than has previously been estimated.
Although several studies have indicated a negative influence of smoking on fracture risk in women, there are few studies in men. No study in either sex has considered that smoking exposure may vary during follow-up in a cohort study. There is a need for a prospective study with repeated measures to analyze smoking exposure and fracture risk in men.
A total of 2322 men, 49-51 years of age, were enrolled in a longitudinal, population-based cohort study. Smoking status and other lifestyle habits were established at baseline and additionally at 60, 70, and 77 years of age. One or more fractures were documented in 272 men during 30 years of follow-up. Cox proportional hazards regression was used to determine the rate ratio (RR) of fracture according to time-dependent smoking habits and covariates.
The overall adjusted fracture risk was increased in current (RR, 2.71; 95% CI, 1.86-3.95) and former smokers (RR, 1.66, 95% CI; 1.18-2.34), and persistent until 30 years after cessation. Among current smokers, the adjusted risk of any fracture increased by 30% (95% CI, 6-58%) for every 5 g of tobacco smoked each day. Smoking duration did not substantially influence fracture risk in either current or former smokers. One-half (52%; 95% CI, 35-65%) of all fractures were attributable to current smoking.
Tobacco smoking seems to be a long-lasting major risk factor for fracture in older men, and the risks depends both on recency of smoking and on the daily amount of tobacco smoked, rather than smoking duration.
在一项基于人群的纵向队列研究中，对吸烟在老年男性骨折风险中的作用进行了研究。通过使用随时间变化的暴露信息和分析，发现吸烟是一种比先前估计更强、剂量依赖性且持续时间更长的骨折风险因素。
尽管多项研究表明吸烟对女性骨折风险有负面影响，但针对男性的此类研究较少。在队列研究中，尚无任何一项针对男性或女性的研究考虑到随访期间吸烟暴露情况可能会有所变化。因此，有必要进行一项采用重复测量的前瞻性研究，以分析男性的吸烟暴露与骨折风险。
共有2322名年龄在49至51岁之间的男性参与了一项基于人群的纵向队列研究。在基线时以及60岁、70岁和77岁时确定吸烟状况和其他生活习惯。在30年的随访期间，有272名男性记录了一处或多处骨折。采用Cox比例风险回归分析，根据随时间变化的吸烟习惯和协变量确定骨折的发生率比（RR）。
当前吸烟者（RR，2.71；95%CI，1.86 - 3.95）和既往吸烟者（RR，1.66，95%CI；1.18 - 2.34）的总体调整后骨折风险增加，且这种风险一直持续到戒烟后30年。在当前吸烟者中，每天每多吸5克烟草，任何骨折的调整后风险增加30%（95%CI，6 - 58%）。吸烟持续时间对当前吸烟者或既往吸烟者的骨折风险均无实质性影响。所有骨折中有一半（52%；95%CI，35 - 65%）可归因于当前吸烟。
吸烟似乎是老年男性骨折的一个长期主要风险因素，其风险既取决于近期吸烟情况，也取决于每日吸烟量，而非吸烟持续时间。
