Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Osteoporos Int. 2012 Mar;23(3):957-62. doi: 10.1007/s00198-011-1648-4. Epub 2011 May 12.
It is not clear whether ankle fractures predict future osteoporotic fractures in women, and whether diabetes influences this relationship. We found that a prior ankle fracture does not predict subsequent osteoporotic fractures in women with or without diabetes.
We aimed to determine: (1) whether a prior ankle fracture was a risk factor for a subsequent major osteoporotic fracture in older women; (2) whether this risk was modified by the presence of diabetes; (3) the risk factors for ankle fracture in older women.
We identified 3,054 women age 50 years and older with diabetes and 9,151 matched controls using the Manitoba Bone Density Program database. Multivariable regression models were used to examine factors associated with prior ankle fracture, and the importance of prior ankle fracture as a predictor of subsequent major osteoporotic fracture during a mean 4.8 years of observation.
A prior ankle fracture was not a significant predictor of subsequent major osteoporotic fracture for women with diabetes (hazard ratio [HR] 1.13; 95% confidence interval [CI], 0.68-1.83; p = 0.623) or women without diabetes (HR 1.16; 95% CI, 0.79-1.71; p = 0.460), and there was no interaction between diabetes and ankle fracture after pooling all women in the cohort (p = 0.971). The presence of diabetes was not independently associated with prior ankle fracture (adjusted odds ratio [OR] 1.14 [95% CI, 0.93-1.38], p = 0.200), whereas higher body mass index (adjusted OR 1.04 per standard deviation increase [95% CI, 1.03-1.06], p < 0.001), previous major osteoporotic fracture (adjusted OR 1.40 [95% CI, 1.13-1.75], p = 0.002), and multiple comorbidities (>6 ambulatory diagnostic groups) (adjusted OR 1.81 [95% CI, 1.40-2.36], p < 0.001) were related to prior ankle fracture.
Ankle fracture was not a significant predictor of major osteoporotic fracture in women, and a diagnosis of diabetes did not influence the relationship.
我们旨在确定：（1）既往踝关节骨折是否是老年女性发生后续主要骨质疏松性骨折的危险因素；（2）这种风险是否受糖尿病的影响；（3）老年女性踝关节骨折的危险因素。
我们使用曼尼托巴骨密度计划数据库，确定了 3054 名年龄在 50 岁及以上患有糖尿病的女性和 9151 名匹配对照者。多变量回归模型用于检查与既往踝关节骨折相关的因素，以及在平均 4.8 年的观察期间，既往踝关节骨折作为后续主要骨质疏松性骨折预测因子的重要性。
对于患有糖尿病的女性（风险比 [HR] 1.13；95%置信区间 [CI]，0.68-1.83；p = 0.623）或没有糖尿病的女性（HR 1.16；95% CI，0.79-1.71；p = 0.460），既往踝关节骨折并不是后续发生主要骨质疏松性骨折的显著预测因子，并且在对队列中所有女性进行汇总后，糖尿病与踝关节骨折之间没有相互作用（p = 0.971）。糖尿病的存在与既往踝关节骨折无关（调整后的优势比 [OR] 1.14 [95% CI，0.93-1.38]，p = 0.200），而较高的体重指数（调整后的 OR 每标准偏差增加 1.04 [95% CI，1.03-1.06]，p < 0.001）、既往主要骨质疏松性骨折（调整后的 OR 1.40 [95% CI，1.13-1.75]，p = 0.002）和多种合并症（>6 个门诊诊断组）（调整后的 OR 1.81 [95% CI，1.40-2.36]，p < 0.001）与既往踝关节骨折相关。
踝关节骨折不是女性发生主要骨质疏松性骨折的显著预测因子，且糖尿病的诊断并未影响这种关系。
