Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Circulation. 2011 Jul 19;124(3):297-303. doi: 10.1161/CIRCULATIONAHA.110.007195. Epub 2011 Jun 27.
Data on the association between myocardial infarction (MI) and fractures are scarce. Recent changes in the epidemiology of MI justify exploring this relationship. We evaluated whether MI constitutes a risk factor for osteoporotic fracture and examined secular trends in this association.
Consecutive Olmsted County, Minnesota, residents with incident MI diagnosed in 1979 to 2006 and community control subjects individually matched (1:1) to cases on age, sex, and year of onset (n=6642) were followed up through 2009. Outcome measures were time to osteoporotic fracture, overall and by anatomic site, and death. Fracture incidence rates were stable in controls but increased markedly over time among MI cases. Accordingly, although an overall excess of fracture risk after MI was observed (adjusted hazard ratio, 1.32; 95% confidence interval, 1.12 to 1.56), substantial temporal variations were noted (1979 to 1989: hazard ratio, 0.81; 95% confidence interval, 0.58 to 1.12; 1990 to 1999: hazard ratio, 1.47; 95% confidence interval, 1.10 to 1.96; 2000 to 2006: hazard ratio, 1.73; 95% confidence interval, 1.32 to 2.27; P for trend <0.001). Trends were similar regardless of age, sex or fracture site. Conversely, the overall hazard ratio for death in MI cases versus controls did not change materially despite a continuous decline in 30-day case fatality rate (12.5% in 1979 to 1989; 6.7% in 2000 to 2006). Observed changes in the baseline prevalence of cardiovascular risk factors, MI characteristics, and comorbidities did not fully account for the trends in fracture risk.
Over the past decades, the association between MI and osteoporotic fractures increased steadily. The trend is consistent with the displacement of post-MI outcomes toward noncardiovascular events, highlighting the need for comprehensive prevention strategies to accommodate the changing epidemiology of MI.
心肌梗死（MI）与骨折之间的关联数据稀缺。最近 MI 流行病学的变化证明了探索这种关系的合理性。我们评估了 MI 是否构成骨质疏松性骨折的危险因素，并研究了这种关联的时间趋势。
连续入组明尼苏达州奥姆斯特德县在 1979 年至 2006 年期间诊断为 MI 的患者和在年龄、性别和发病年份上与病例（n=6642）一对一匹配的社区对照者，随访至 2009 年。结局指标为骨质疏松性骨折的时间、总体和按解剖部位，以及死亡。在对照组中，骨折发生率保持稳定，但在 MI 病例中随时间明显增加。因此，尽管观察到 MI 后骨折风险总体增加（调整后的危险比，1.32；95%置信区间，1.12 至 1.56），但也注意到了显著的时间变化（1979 年至 1989 年：危险比，0.81；95%置信区间，0.58 至 1.12；1990 年至 1999 年：危险比，1.47；95%置信区间，1.10 至 1.96；2000 年至 2006 年：危险比，1.73；95%置信区间，1.32 至 2.27；P 趋势<0.001）。无论年龄、性别或骨折部位如何，趋势都相似。相反，尽管 30 天病死率持续下降（1979 年至 1989 年为 12.5%；2000 年至 2006 年为 6.7%），MI 病例与对照组的总体死亡危险比并未发生实质性变化。观察到的心血管危险因素、MI 特征和合并症的基线患病率变化并未完全解释骨折风险的趋势。
在过去几十年中，MI 与骨质疏松性骨折之间的关联稳步增加。这种趋势与 MI 后结局向非心血管事件转移一致，突出了需要综合预防策略来适应 MI 流行病学的变化。
