女性和男性骨折的残余终生风险。

Residual lifetime risk of fractures in women and men.

作者信息

Nguyen Nguyen D, Ahlborg Henrik G, Center Jacqueline R, Eisman John A, Nguyen Tuan V

机构信息

Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia.

出版信息

J Bone Miner Res. 2007 Jun;22(6):781-8. doi: 10.1359/jbmr.070315.

DOI:10.1359/jbmr.070315

PMID:17352657

Abstract

UNLABELLED

In a sample of 1358 women and 858 men, > or = 60 yr of age who have been followed-up for up to 15 yr, it was estimated that the mortality-adjusted residual lifetime risk of fracture was 44% for women and 25% for men. Among those with BMD T-scores < or = -2.5, the risks increased to 65% in women and 42% in men.

INTRODUCTION

Risk assessment of osteoporotic fracture is shifting from relative risk to an absolute risk approach. Whereas BMD is a primary predictor of fracture risk, there has been no estimate of mortality-adjusted lifetime risk of fracture by BMD level. The aim of the study was to estimate the residual lifetime risk of fracture (RLRF) in elderly men and women.

MATERIALS AND METHODS

Data from 1358 women and 858 men > or = 60 yr of age as of 1989 of white background from the Dubbo Osteoporosis Epidemiology Study were analyzed. The participants have been followed for up to 15 yr. During the follow-up period, incidence of low-trauma, nonpathological fractures, confirmed by X-ray and personal interview, were recorded. Incidence of mortality was also recorded. BMD at the femoral neck was measured by DXA (GE-LUNAR) at baseline. Residual lifetime risk of fracture from the age of 60 was estimated by the survival analysis taking into account the competing risk of death.

RESULTS

After adjusting for competing risk of death, the RLRF for women and men from age 60 was 44% (95% CI, 40-48) and 25% (95% CI, 19-31), respectively. For individuals with osteoporosis (BMD T-scores < or = -2.5), the mortality-adjusted lifetime risk of any fracture was 65% (95% CI, 58-73) for women and 42% (95% CI, 24-71) for men. For the entire cohort, the lifetime risk of hip fracture was 8.5% (95% CI, 6-11%) for women and 4% (95% CI, 1.3-5.4%) for men; risk of symptomatic vertebral fracture was 18% (95% CI, 15-21%) for women and 11% (95% CI, 7-14%) for men.

CONCLUSIONS

These estimates provide a means to communicate the absolute risk of fracture to an individual patient and can help promote the identification and targeting of high-risk individuals for intervention.

摘要

未标注

在1358名女性和858名男性样本中，年龄≥60岁，随访长达15年，估计经死亡率调整后的骨折残余终生风险女性为44%，男性为25%。在骨密度T值≤ -2.5的人群中，女性风险增至65%，男性增至42%。

引言

骨质疏松性骨折的风险评估正从相对风险转向绝对风险方法。虽然骨密度是骨折风险的主要预测指标，但尚未有根据骨密度水平对经死亡率调整的骨折终生风险进行估计。本研究的目的是估计老年男性和女性的骨折残余终生风险（RLRF）。

材料与方法

分析了来自达博骨质疏松症流行病学研究的1358名女性和858名年龄≥60岁、具有白人背景的男性的数据，这些参与者已被随访长达15年。在随访期间，记录经X射线和个人访谈确认的低创伤、非病理性骨折的发生率，也记录死亡率。在基线时通过双能X线吸收法（GE-LUNAR）测量股骨颈骨密度。考虑到死亡的竞争风险，通过生存分析估计60岁起的骨折残余终生风险。

结果

在调整死亡竞争风险后，60岁起女性和男性的RLRF分别为44%（95%置信区间，40 - 48）和25%（95%置信区间，19 - 31）。对于患有骨质疏松症（骨密度T值≤ -2.5）的个体，经死亡率调整后的任何骨折终生风险女性为65%（95%置信区间，58 - 73），男性为42%（95%置信区间，24 - 71）。对于整个队列，女性髋部骨折的终生风险为8.5%（95%置信区间，6 - 11%），男性为4%（95%置信区间，1.3 - 5.4%）；有症状椎体骨折的风险女性为18%（95%置信区间，15 - 21%），男性为11%（95%置信区间，7 - 14%）。