Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0607, USA.
BMJ. 2010 Mar 15;340:c1069. doi: 10.1136/bmj.c1069.
To study the causes and consequences of radiologically confirmed rib fractures (seldom considered in the context of osteoporosis) in community dwelling older men.
Prospective cohort study (Osteoporotic Fractures in Men (MrOS) Study).
5995 men aged 65 or over recruited in 2000-2 from six US sites; 99% answered mailed questionnaires about falls and fractures every four months for a mean 6.2 (SD 1.3) year follow-up.
New fractures validated by radiology reports; multivariate Cox proportional hazard ratios were used to evaluate factors independently associated with time to incident rib fracture; associations between baseline rib fracture and incident hip and wrist fracture were also evaluated.
The incidence of rib fracture was 3.5/1000 person years, and 24% (126/522) of all incident non-spine fractures were rib fractures. Nearly half of new rib fractures (48%; n=61) followed falling from standing height or lower. Independent risk factors for an incident rib fracture were age 80 or above, low bone density, difficulty with instrumental activities of daily living, and a baseline history of rib/chest fracture. Men with a history of rib/chest fracture had at least a twofold increased risk of an incident rib fracture (adjusted hazard ratio 2.71, 95% confidence interval 1.86 to 3.95), hip fracture (2.05, 1.33 to 3.15), and wrist fracture (2.06, 1.14 to 3.70). Only 14/82 of men reported being treated with bone specific drugs after their incident rib fracture.
Rib fracture, the most common incident clinical fracture in men, was associated with classic risk markers for osteoporosis, including old age, low hip bone mineral density, and history of fracture. A history of rib fracture predicted a more than twofold increased risk of future fracture of the rib, hip, or wrist, independent of bone density and other covariates. Rib fractures should be considered to be osteoporotic fractures in the evaluation of older men for treatment to prevent future fracture.
研究社区居住的老年男性中经影像学证实的肋骨骨折（很少在骨质疏松症的背景下考虑）的原因和后果。
前瞻性队列研究（男性骨质疏松性骨折研究）。
2000-2002 年从美国 6 个地点招募了 5995 名年龄在 65 岁或以上的男性；99%的人回答了关于跌倒和骨折的邮寄问卷，平均随访 6.2（SD 1.3）年。
通过放射学报告验证的新骨折；多变量 Cox 比例风险比用于评估与发生肋骨骨折时间相关的独立因素；还评估了基线肋骨骨折与新发髋部和腕部骨折之间的关系。
肋骨骨折的发生率为 3.5/1000 人年，24%（126/522）的所有非脊柱新发骨折为肋骨骨折。近一半的新发肋骨骨折（48%；n=61）是由从站立高度或更低处跌倒引起的。新发肋骨骨折的独立危险因素包括 80 岁或以上、骨密度低、日常生活活动困难以及基线肋骨/胸部骨折史。有肋骨/胸部骨折史的男性发生新发肋骨骨折的风险至少增加两倍（调整后的危险比 2.71，95%置信区间 1.86 至 3.95），髋部骨折（2.05，1.33 至 3.15）和腕部骨折（2.06，1.14 至 3.70）。只有 14/82 名男性报告在发生肋骨骨折后接受了针对骨骼的特定药物治疗。
肋骨骨折是男性最常见的临床新发骨折，与骨质疏松的典型危险因素相关，包括年龄较大、髋部骨密度低和骨折史。肋骨骨折史预测未来肋骨、髋部或腕部骨折的风险增加两倍以上，与骨密度和其他协变量无关。在评估老年男性是否需要治疗以预防未来骨折时，应将肋骨骨折视为骨质疏松性骨折。
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