Harness Neil G, Funahashi Tadashi, Dell Richard, Adams Annette L, Burchette Raoul, Chen Xuan, Greene Denise
Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Kaiser Orange County Medical Center, University of California Irvine, Orange, CA, USA.
J Hand Surg Am. 2012 Aug;37(8):1543-9. doi: 10.1016/j.jhsa.2012.04.033. Epub 2012 Jun 28.
To study risk factors associated with osteoporotic distal radius fractures and evaluate the effectiveness of the screening and treatment components of a comprehensive osteoporosis program.
We retrospectively identified a cohort of patients aged 60 years or older from a large health maintenance organization. For the period 2002 to 2008, information on age, race, sex, diabetes status, osteoporosis diagnosis, osteoporosis screening activity, medications dispensed, and fracture events, including distal radius, proximal humerus, and hip fractures were recorded. We compared demographic and clinical characteristics for patients with and without distal radius fractures. We estimated multivariable estimates of the associations between pharmacologic treatment, and osteoporosis screening and distal radius fracture risk using Cox proportional hazards methods, and adjusted them for age, sex, race, diabetes status, and prior history of hip or proximal humerus fractures.
Overall, 1.7% of the cohort (n = 8,658) of the study population (N = 524,612) sustained a new distal radius fracture during 2002 to 2008. In the multivariable model, we found that patients who received pharmacological intervention were 48% less likely to sustain a distal radius fracture. Similarly, patients who were screened for osteoporosis were 83% less likely to sustain a distal radius fracture. Patients with osteoporosis were 8.9 times more likely to have a distal radius fracture than patients without osteoporosis. White subjects had a 1.6 times higher risk of distal radius fracture than non-whites, and women had a 3.8 times higher risk than men.
White race, female sex, and a diagnosis of osteoporosis are high risks for distal radius fracture. Screening for and pharmacologic management of osteoporosis using a multidisciplinary team approach in a comprehensive osteoporosis management program resulted in a statistically significant decrease in the risk of distal radius fracture.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
研究与骨质疏松性桡骨远端骨折相关的危险因素，并评估一项综合性骨质疏松项目的筛查与治疗措施的有效性。
我们从一个大型健康维护组织中回顾性地确定了一组60岁及以上的患者。在2002年至2008年期间，记录了年龄、种族、性别、糖尿病状况、骨质疏松症诊断、骨质疏松症筛查活动、所配发药物以及骨折事件（包括桡骨远端、肱骨近端和髋部骨折）等信息。我们比较了有和没有桡骨远端骨折患者的人口统计学和临床特征。我们使用Cox比例风险方法估计了药物治疗、骨质疏松症筛查与桡骨远端骨折风险之间关联的多变量估计值，并对年龄、性别、种族、糖尿病状况以及髋部或肱骨近端骨折的既往史进行了调整。
总体而言，在2002年至2008年期间，研究人群（N = 524,612）中的1.7%（n = 8,658）发生了新的桡骨远端骨折。在多变量模型中，我们发现接受药物干预的患者发生桡骨远端骨折的可能性降低了48%。同样，接受骨质疏松症筛查的患者发生桡骨远端骨折的可能性降低了83%。患有骨质疏松症的患者发生桡骨远端骨折的可能性是未患骨质疏松症患者的8.9倍。白人受试者发生桡骨远端骨折的风险是非白人的1.6倍，女性的风险是男性的3.8倍。
白人种族、女性以及骨质疏松症诊断是桡骨远端骨折的高风险因素。在综合性骨质疏松管理项目中，采用多学科团队方法对骨质疏松症进行筛查和药物管理，导致桡骨远端骨折风险在统计学上显著降低。
研究类型/证据水平：治疗性III级。
