Centre for Bone and Arthritis Research at the Sahlgrenska Academy, Institute of Medicine, University of Göteborg, Göteborg, Sweden.
J Bone Miner Res. 2011 Apr;26(4):865-72. doi: 10.1002/jbmr.281.
Osteoporosis-related fractures constitute a major health concern not only in women but also in men. Insulin-like growth factor 1 (IGF-1) is a key determinant of bone mass, but the association between serum IGF-1 and incident fractures in men remains unclear. To determine the predictive value of serum IGF-1 for fracture risk in men, older men (n = 2902, mean age of 75 years) participating in the prospective, population-based Osteoporotic Fractures in Men (MrOS) Sweden study were followed for a mean of 3.3 years. Serum IGF-1 was measured at baseline by radioimmunoassay. Fractures occurring after the baseline visit were validated. In age-adjusted hazards regression analyses, serum IGF-1 associated inversely with risk of all fractures [hazard ratio (HR) per SD decrease = 1.23, 95% confidence interval (CI) 1.07-1.41], hip fractures (HR per SD decrease = 1.45, 95% CI 1.07-1.97), and clinical vertebral fractures (HR per SD decrease = 1.40, 95% CI 1.10-1-78). The predictive role of serum IGF-1 for fracture risk was unaffected by adjustment for height, weight, prevalent fractures, falls, and major prevalent diseases. Further adjustment for bone mineral density (BMD) resulted in an attenuated but still significant association between serum IGF-1 and fracture risk. Serum IGF-1 below but not above the median was inversely related to fracture incidence. The population-attributable risk proportion was 7.5% for all fractures and 22.9% for hip fractures. Taken together, older men with low serum IGF-1 have an increased fracture risk, especially for the two most important fracture types, hip and vertebral fractures. The association between serum IGF-1 and fracture risk is partly mediated via BMD.
骨质疏松症相关骨折不仅是女性，也是男性的主要健康关注点。胰岛素样生长因子 1（IGF-1）是骨量的关键决定因素，但血清 IGF-1 与男性骨折事件之间的关系尚不清楚。为了确定血清 IGF-1 对男性骨折风险的预测价值，参加前瞻性、基于人群的男性骨质疏松症研究（MrOS 瑞典）的老年男性（n=2902 人，平均年龄 75 岁）在基线时通过放射免疫分析测量血清 IGF-1。随访平均 3.3 年，随访期间记录骨折事件。经年龄调整后的风险回归分析表明，血清 IGF-1 与所有骨折的风险呈负相关[每标准差降低的风险比（HR）=1.23，95%置信区间（CI）1.07-1.41]，髋部骨折（每标准差降低的 HR=1.45，95%CI 1.07-1.97）和临床椎体骨折（每标准差降低的 HR=1.40，95%CI 1.10-1.78）。血清 IGF-1 对骨折风险的预测作用不受身高、体重、既往骨折、跌倒和主要疾病的影响。进一步调整骨密度（BMD）后，血清 IGF-1 与骨折风险之间仍存在显著关联，但有所减弱。血清 IGF-1 低于但不高于中位数与骨折发生率呈负相关。所有骨折的人群归因风险比例为 7.5%，髋部骨折为 22.9%。综上所述，血清 IGF-1 水平低的老年男性骨折风险增加，尤其是髋部和椎体这两种最重要的骨折类型。血清 IGF-1 与骨折风险之间的关联部分通过 BMD 介导。
