Department of General Practice, Maastricht University/Caphri School for Public Health and Primary Care, Maastricht, The Netherlands.
Ann Rheum Dis. 2011 Jan;70(1):92-7. doi: 10.1136/ard.2010.131813. Epub 2010 Sep 27.
Previous fracture prediction models have been based on the assumption of a stable risk of subsequent fractures over time. The aim of the present work was to develop a nomogram for prediction of 5-year and 10-year individualised absolute fracture risks for postmenopausal women taking into account the time relation between fractures.
A population-based prospective study was performed in 23 general practice centres located in the southern part of The Netherlands. At baseline (1992-1994), 4203 postmenopausal women between 50 and 80 years participated and 2372 of them also participated 10 years later. Baseline measurements included lumbar spine bone mineral density (BMD) and clinical risk factor evaluation. The incidence of fractures was ascertained. Bayesian model averaging and Cox's proportional hazards model were used.
After enrolment, 382 (16.1%) women had a clinical fracture. Fracture risk was associated with advancing age (HR 1.09 per SD (5 years); 95% CI 1.01 to 1.17), lumbar spine BMD (HR 1.23 per -1 SD; 95% CI 1.10 to 1.37) and a prior fracture, with HR 3.27 (95% CI 2.50 to 4.30) for a recent prior fracture (≤5 years previously) and HR 1.97 (95% CI 1.43 to 2.71) for a non-recent prior fracture after menopause (>5 years previously). Women with a recent prior fracture had 66% higher risk of an incident fracture than those with a non-recent prior fracture (HR 1.66; 95% CI 1.15 to 2.40).
The nomogram developed can help doctors to inform patients more effectively and thus better manage patient care by providing an individualised fracture risk taking into account the time relationship for fractures.
之前的骨折预测模型基于这样一种假设，即随着时间的推移，随后骨折的风险是稳定的。本研究旨在开发一个预测模型，用于预测接受治疗的绝经后女性 5 年和 10 年的个体化绝对骨折风险，并考虑骨折之间的时间关系。
本研究是一项基于人群的前瞻性研究，在荷兰南部的 23 个普通诊所进行。在基线（1992-1994 年）时，4203 名 50-80 岁的绝经后女性参加了研究，其中 2372 名女性在 10 年后也参加了研究。基线测量包括腰椎骨密度（BMD）和临床危险因素评估。通过确定骨折的发生率来评估骨折风险。采用贝叶斯模型平均法和考克斯比例风险模型进行分析。
入组后，382 名（16.1%）女性发生了临床骨折。骨折风险与年龄增长（每增加 5 岁，风险比[HR]为 1.09；95%可信区间[CI]为 1.01 至 1.17）、腰椎 BMD（每减少 1 个标准差[SD]，HR 为 1.23；95%CI 为 1.10 至 1.37）和既往骨折有关，最近一次骨折（<5 年前）的 HR 为 3.27（95%CI 为 2.50 至 4.30），绝经后>5 年前的非近期骨折的 HR 为 1.97（95%CI 为 1.43 至 2.71）。最近一次骨折的女性发生骨折的风险比非近期骨折的女性高 66%（HR 为 1.66；95%CI 为 1.15 至 2.40）。
开发的预测模型可以帮助医生更有效地告知患者，通过提供考虑骨折时间关系的个体化骨折风险，从而更好地管理患者的护理。
