Clinton Jeremiah, Franta Amy, Polissar Nayak L, Neradilek Blazej, Mounce Doug, Fink Howard A, Schousboe John T, Matsen Frederick A
Department of Orthopaedics, University of Washington, Seattle, WA 98195, USA.
J Bone Joint Surg Am. 2009 Mar 1;91(3):503-11. doi: 10.2106/JBJS.G.01529.
With the aging of the world's population, the social and economic implications of osteoporotic fractures are at epidemic proportions. This study was performed to test the hypothesis that a proximal humeral fracture is an independent risk factor for a subsequent hip fracture and that the risk of the subsequent hip fracture is highest within the first five years after the humeral fracture.
A cohort of 8049 older white women with no history of a hip or humeral fracture who were enrolled in the Study of Osteoporotic Fractures was followed for a mean of 9.8 years. The risk of hip fracture after an incident humeral fracture was estimated with use of age-adjusted Cox proportional hazards regression analysis with time-varying variables; women without a humeral fracture were the reference group. Cox regression analysis was used to evaluate the timing between the proximal humeral and subsequent hip fracture. Risk factors were determined on the basis of a review of the current literature, and we chose the variables that were most predictive and easily ascertained in a clinical setting.
Three hundred and twenty-one women sustained a proximal humeral fracture, and forty-four of them sustained a subsequent hip fracture. After adjustment for age and bone mineral density, the hazard ratio for hip fracture for subjects with a proximal humeral fracture relative to those without a proximal humeral fracture was 1.83 (95% confidence interval = 1.32 to 2.53). After multivariate adjustment, this risk appeared attenuated but was still significant (hazard ratio = 1.57; 95% confidence interval = 1.12 to 2.19). The risk of a subsequent hip fracture after a proximal humeral fracture was highest within one year after the proximal humeral fracture, with a hazard ratio of 5.68 (95% confidence interval = 3.70 to 8.73). This association between humeral and hip fracture was not significant after the first year, with hazard ratios of 0.87 (95% confidence interval = 0.48 to 1.59) between one and five years after the humeral fracture and 0.58 (95% confidence interval = 0.22 to 1.56) after five years.
In this cohort of older white women, a proximal humeral fracture independently increased the risk of a subsequent hip fracture more than five times in the first year after the humeral fracture but was not associated with a significant increase in the hip fracture risk in subsequent years.
随着世界人口老龄化，骨质疏松性骨折的社会和经济影响正呈流行态势。本研究旨在验证以下假设：肱骨近端骨折是随后发生髋部骨折的独立危险因素，且在肱骨骨折后的头五年内，随后发生髋部骨折的风险最高。
对8049名无髋部或肱骨骨折病史的老年白人女性进行队列研究，平均随访9.8年。采用年龄调整的Cox比例风险回归分析和时变变量来估计肱骨骨折后发生髋部骨折的风险；无肱骨骨折的女性作为参照组。采用Cox回归分析评估肱骨近端骨折与随后髋部骨折之间的时间间隔。根据对当前文献的回顾确定危险因素，我们选择了在临床环境中最具预测性且易于确定的变量。
321名女性发生了肱骨近端骨折，其中44人随后发生了髋部骨折。在调整年龄和骨密度后，肱骨近端骨折患者相对于无肱骨近端骨折患者发生髋部骨折的风险比为1.83（95%置信区间=1.32至2.53）。经过多变量调整后，这种风险似乎有所降低，但仍然显著（风险比=1.57；95%置信区间=1.12至2.19）。肱骨近端骨折后发生随后髋部骨折的风险在肱骨近端骨折后一年内最高，风险比为5.68（95%置信区间=3.70至8.73）。在第一年之后，肱骨骨折与髋部骨折之间的这种关联不显著，肱骨骨折后1至5年的风险比为0.87（95%置信区间=0.48至1.59），5年后为0.58（95%置信区间=0.22至1.56）。
在这个老年白人女性队列中，肱骨近端骨折在肱骨骨折后的第一年独立增加随后髋部骨折的风险超过五倍，但在随后几年与髋部骨折风险的显著增加无关。
