McCarthy James T, Rule Andrew D, Achenbach Sara J, Bergstralh Eric J, Khosla Sundeep, Melton L Joseph
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clin Proc. 2008 Nov;83(11):1231-9. doi: 10.4065/83.11.1231.
To determine whether factors associated with moderate chronic kidney disease can be used to independently predict fracture risk in postmenopausal white women by analyzing the effect of adding renal function measurements to traditional risk factors (eg, age, body weight, bone mineral density) for fracture risk assessment.
In a prospective, population-based cohort study, postmenopausal women residing in Rochester, MN, with baseline measurements of bone mineral density and renal function were followed up for as long as 25 years for occurrence of fractures. Participants were enrolled in 1980-1984 or 1991-1993, and outcomes were analyzed in 2007. Standardized incidence ratios were used to compare the number of observed fractures with the number of predicted fractures, and potential risk factors were evaluated with Andersen-Gill time-to-fracture regression models.
During 5948 person-years of follow-up of 427 women, 254 women (59.5%) experienced a total of 563 fractures, 394 (70.0%) of which resulted from moderate trauma. Excluding incidentally diagnosed fractures, the 186 clinically diagnosed fractures were statistically undifferentiated from the 195 predicted fractures (standardized incidence ratio, 0.95; 95% confidence interval, 0.82-1.10). No significant trends were observed toward increasing fracture risk with inclusion of quintiles of declining renal function (P>.10). In univariate analyses, serum creatinine concentration, creatinine clearance rate, and estimated glomerular filtration rate were associated with greater risk of some fractures. In multivariate analyses, however, decreasing renal function was not found to be a significant risk factor, after adjusting for age, body weight, and bone mineral density.
The addition of serum creatinine concentration, creatinine clearance rate, or estimated glomerular filtration rate does not improve fracture risk prediction in postmenopausal white women who have moderate chronic kidney disease. This result can be partly explained by the fact that important risk factors for decreased renal function (eg, advanced age, lower body weight) are already accounted for in most fracture prediction models.
通过分析将肾功能测量值添加到传统骨折风险评估危险因素（如年龄、体重、骨密度）中所产生的影响，确定与中度慢性肾病相关的因素是否可用于独立预测绝经后白人女性的骨折风险。
在一项基于人群的前瞻性队列研究中，对居住在明尼苏达州罗切斯特市、进行了骨密度和肾功能基线测量的绝经后女性进行了长达25年的随访，以观察骨折的发生情况。参与者于1980 - 1984年或1991 - 1993年入组，并于2007年对结果进行分析。使用标准化发病率比来比较观察到的骨折数量与预测的骨折数量，并使用安德森 - 吉尔骨折时间回归模型评估潜在危险因素。
在对427名女性进行的5948人年随访期间，254名女性（59.5%）共发生了563例骨折，其中394例（70.0%）由中度创伤引起。排除偶然诊断的骨折后，186例临床诊断的骨折与195例预测的骨折在统计学上无差异（标准化发病率比，0.95；95%置信区间，0.82 - 1.10）。未观察到随着肾功能下降五分位数的纳入骨折风险增加的显著趋势（P > 0.10）。在单变量分析中，血清肌酐浓度、肌酐清除率和估计肾小球滤过率与某些骨折的风险增加相关。然而，在多变量分析中，在调整年龄、体重和骨密度后，未发现肾功能下降是一个显著的危险因素。
添加血清肌酐浓度、肌酐清除率或估计肾小球滤过率并不能改善中度慢性肾病绝经后白人女性的骨折风险预测。这一结果部分可以通过以下事实来解释，即大多数骨折预测模型中已经考虑了肾功能下降的重要危险因素（如高龄、低体重）。
