Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M
Cochin Hospital, Rheumatology Department, University of Paris, 27, rue du Faubourg St Jacques, 75014, Paris, France.
Osteoporos Int. 2007 Dec;18(12):1617-24. doi: 10.1007/s00198-007-0413-1. Epub 2007 Jul 5.
This prospective four-year study indicates that post-menopausal osteoporotic women with mild prevalent and incident vertebral fractures have an increased risk of incident fractures.
Mild vertebral fractures are under diagnosed as there is disagreement about their clinical significance. Our aim was to assess the risk of subsequent fractures induced by both prevalent and incident mild vertebral fractures in osteoporotic post-menopausal women.
Three thousand three hundred and fifty-eight patients, aged 74 +/- 6 years, with post-menopausal osteoporosis included in the placebo groups of two clinical trials of strontium ranelate were followed for 4 years. A Cox regression model adjusted on age, body mass index and bone mineral density was used to calculate the relative risk (RR) of fracture in subjects with only mild fractures as compared to patients without fracture, and to patients with at least one grade >or= 2 fracture. These calculations were made for prevalent and then incident fractures.
The RR of vertebral fracture in 4 years was 1.8 (1.3-2.4) p < 0.001, and 2.7 (2.3-3.3) p < 0.001 for patients having only mild vertebral fractures and at least one grade >or= 2 fracture at baseline respectively. The RR of vertebral fracture in the 3rd and 4th years of follow-up was 1.7 (1.1-2.6) p = 0.01, and 1.9 (1.3-2.6) p < 0.001 for patients having during the first 2 years incident mild fractures only, and for patients having at least one grade >or= 2 incident fracture respectively. The RR of non-vertebral fracture in 4 years was 1.3 (0.9-1.9) p = 0.15 and 1.7 (1.4-2.1) p < 0.001 for patients having only mild or at least one grade >or= 2 vertebral fracture at baseline respectively. For patients aged more than 70 years, these RR were 1.45 (0.99-2.11) (p = 0.06), and 1.72 (1.36-2.18) p < 0.001 respectively. The RR of non-vertebral fracture in the 3rd and 4th years was 1.68 (1.36-2.09) p < 0.001 for patients having at least one grade >or= 2 incident fracture during the 2 first years of follow-up.
Mild vertebral fractures are a risk factor for subsequent vertebral and non-vertebral fracture in postmenopausal women with osteoporosis; 1 out of 4 patients with an incident mild vertebral fracture in 2 years will fracture again within the 2 next years.
这项为期四年的前瞻性研究表明，患有轻度既往和新发椎体骨折的绝经后骨质疏松女性发生新发骨折的风险增加。
由于对轻度椎体骨折的临床意义存在分歧，其诊断不足。我们的目的是评估骨质疏松绝经后女性中既往和新发轻度椎体骨折导致后续骨折的风险。
对两项雷奈酸锶临床试验安慰剂组中纳入的3358例年龄为74±6岁的绝经后骨质疏松患者进行了4年的随访。使用根据年龄、体重指数和骨密度调整的Cox回归模型，计算仅患有轻度骨折的受试者与无骨折患者以及至少有一处≥2级骨折患者相比的骨折相对风险（RR）。这些计算分别针对既往骨折和新发骨折进行。
基线时仅患有轻度椎体骨折和至少有一处≥2级骨折的患者，4年内椎体骨折的RR分别为1.8（1.3 - 2.4），p < 0.001和2.7（2.3 - 3.3），p < 0.001。在随访的第3年和第4年，仅在头2年有新发轻度骨折的患者以及至少有一处≥2级新发骨折的患者，椎体骨折的RR分别为1.7（1.1 - 2.6），p = 0.01和1.9（1.3 - 2.6），p < 0.001。基线时仅患有轻度或至少有一处≥2级椎体骨折的患者，4年内非椎体骨折的RR分别为1.3（0.9 - 1.9），p = 0.15和1.7（1.4 - 2.1），p < 0.001。对于年龄超过70岁的患者，这些RR分别为1.45（0.99 - 2.11）（p = 0.06）和1.72（1.36 - 2.18），p < 0.001。在随访的头2年至少有一处≥2级新发骨折的患者，第3年和第4年非椎体骨折的RR为1.68（1.36 - 2.09），p < 0.001。
轻度椎体骨折是骨质疏松绝经后女性后续椎体和非椎体骨折的危险因素；2年内发生新发轻度椎体骨折的患者中，每4人中有1人在接下来的2年内会再次骨折。
