Shiraki Masataka, Kuroda Tatsuhiko, Tanaka Shiro
Department of Internal Medicine, Research Institute and Practice for Involutional Diseases, Japan.
Intern Med. 2011;50(5):397-404. doi: 10.2169/internalmedicine.50.4437. Epub 2011 Mar 1.
Osteoporosis has been reported to increase the risk of mortality. However, these reports did not evaluate the effects of co-mobidities and the severity of osteoporosis on mortality. The aim of our study was to determine whether or not major osteoporotic fractures contribute to the increased mortality risk in Japanese women.
We conducted a prospective observational study. Risk factors contributing to mortality were assessed by Cox's proportional hazard model.
A total of 1,429 ambulatory postmenopausal female volunteers aged over 50 years old were enrolled in the study. Information was obtained from the subjects on baseline biochemical indices, bone mineral density (BMD), prevalent fractures, and co-morbidities. Mortality was assessed and confirmed by the certificates or hospital records. The subjects were classified into three categories in accordance with or without osteoporosis. The osteoporotic group was further categorized by the basis of the presence or absence of major osteoporotic fractures.
Mean age and SD of the participants were 66.5±9.3 (50-90) years old. The participants were followed for a total of 4.5±3.5 years (mean ± SD) and a total of 141 participants (9.9%) died during the observation. In addition to the traditional risks for mortality, such as age (Hazard ratio, 2.817, 95% CI, 2.237-3.560, p<0.0001), BMI (HR 0.504, 0.304-0.824, p=0.0061), prevalent malignancies (HR 2.885, 1.929-4.214, p<0.0001), dementia (HR 1.602, 1.027-2.450, p=0.038) and cardio-vascular disease (HR 1.878, 1.228-2.787, p=0.0043), the serum level of creatinine (HR 2.451, 1.107-5.284, p=0.027) and severity of osteoporosis (HR 1.390, 1.129-1.719, P=0.0018) were found to be significant independent risk factors for all-cause mortality.
These results emphasize the importance of osteoporotic fracture in terms of survival.
据报道，骨质疏松症会增加死亡风险。然而，这些报告并未评估合并症及骨质疏松症严重程度对死亡率的影响。我们研究的目的是确定在日本女性中，严重骨质疏松性骨折是否会导致死亡风险增加。
我们开展了一项前瞻性观察性研究。采用Cox比例风险模型评估导致死亡的风险因素。
共有1429名年龄超过50岁的绝经后门诊女性志愿者参与了本研究。收集了研究对象的基线生化指标、骨密度（BMD）、既往骨折情况及合并症等信息。通过证书或医院记录评估并确认死亡率。根据是否患有骨质疏松症将研究对象分为三类。骨质疏松组再根据是否发生严重骨质疏松性骨折进一步分类。
参与者的平均年龄和标准差分别为66.5±9.3（50 - 90）岁。参与者总共随访了4.5±3.5年（均值±标准差），观察期间共有141名参与者（9.9%）死亡。除了年龄（风险比，2.817，95%可信区间，2.237 - 3.560，p<0.0001）、体重指数（HR 0.504，0.304 - 0.824，p = 0.0061）、既往恶性肿瘤（HR 2.885，1.929 - 4.214，p<0.0001）、痴呆（HR 1.602，1.027 - 2.450，p = 0.038）和心血管疾病（HR 1.878，1.228 - 2.787，p = 0.0043）等传统死亡风险因素外，血清肌酐水平（HR 2.451，1.107 - 5.284，p = 0.027）和骨质疏松症严重程度（HR 1.390，1.129 - 1.719，P = 0.0018）被发现是全因死亡率的显著独立风险因素。
这些结果强调了骨质疏松性骨折在生存方面的重要性。
