Eriksson Anna L, Movérare-Skrtic Sofia, Ljunggren Östen, Karlsson Magnus, Mellström Dan, Ohlsson Claes
Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Bone Miner Res. 2014 Feb;29(2):418-23. doi: 10.1002/jbmr.2037.
Epidemiological studies have shown low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) to be associated with fracture risk in women. However, it is still unclear whether hs-CRP is also associated with fracture risk in men. We therefore measured serum levels of hs-CRP in 2910 men, mean age 75 years, included in the prospective population-based MrOS Sweden cohort. Study participants were divided into tertile groups based on hs-CRP level. Fractures occurring after the baseline visit were validated (average follow-up 5.4 years). The incidence for having at least one fracture after baseline was 23.9 per 1000 person-years. In Cox proportional hazard regression analyses adjusted for age, hs-CRP was related to fracture risk. The hazard ratio (HR) of fracture for the highest tertile of hs-CRP, compared with the lowest and the medium tertiles combined, was 1.48 (95% CI, 1.20-1.82). Multivariate adjustment for other risk factors for fractures had no major effect on the associations between hs-CRP and fracture. Results were essentially unchanged after exclusion of subjects with hs-CRP levels greater than 7.5 mg/L, as well as after exclusion of subjects with a first fracture within 3 years of follow-up, supporting that the associations between hs-CRP and fracture risk were not merely a reflection of a poor health status at the time of serum sampling. Femoral neck bone mineral density (BMD) was not associated with hs-CRP, and the predictive role of hs-CRP for fracture risk was essentially unchanged when femoral neck BMD was added to the model (HR, 1.37; 95% CI, 1.09-1.72). Exploratory subanalyses of fracture type demonstrated that hs-CRP was clearly associated with clinical vertebral fractures (HR, 1.61; 95% CI, 1.12-2.29). We demonstrate, using a large prospective population-based study, that elderly men with high hs-CRP have increased risk of fractures, and that these fractures are mainly vertebral. The association between hs-CRP and fractures was independent of BMD. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
流行病学研究表明，通过高敏C反应蛋白（hs-CRP）检测到的低度炎症与女性骨折风险相关。然而，hs-CRP是否也与男性骨折风险相关仍不清楚。因此，我们测量了纳入基于人群的前瞻性瑞典MrOS队列研究中的2910名平均年龄75岁男性的血清hs-CRP水平。研究参与者根据hs-CRP水平分为三分位数组。对基线访视后发生的骨折进行了验证（平均随访5.4年）。基线后至少发生一次骨折的发生率为每1000人年23.9例。在针对年龄进行调整的Cox比例风险回归分析中，hs-CRP与骨折风险相关。与最低三分位数和中间三分位数合并组相比，hs-CRP最高三分位数组的骨折风险比（HR）为1.48（95%CI，1.20-1.82）。对其他骨折风险因素进行多变量调整对hs-CRP与骨折之间的关联没有重大影响。排除hs-CRP水平大于7.5mg/L的受试者以及排除随访3年内首次发生骨折的受试者后，结果基本不变，这支持了hs-CRP与骨折风险之间的关联不仅仅反映血清采样时的健康状况不佳。股骨颈骨密度（BMD）与hs-CRP无关，当将股骨颈BMD添加到模型中时，hs-CRP对骨折风险的预测作用基本不变（HR，1.37；95%CI，1.09-1.72）。对骨折类型的探索性亚组分析表明，hs-CRP与临床椎体骨折明显相关（HR，1.61；95%CI，1.12-2.29）。我们通过一项基于人群的大型前瞻性研究证明，hs-CRP水平高的老年男性骨折风险增加，且这些骨折主要是椎体骨折。hs-CRP与骨折之间的关联独立于BMD。本文是一篇根据知识共享署名-非商业性使用-禁止演绎许可条款的开放获取文章，允许在任何媒介中使用和传播，前提是正确引用原始作品，使用是非商业性的，且不进行任何修改或改编。
