Amin Shreyasee, Achenbach Sara J, Atkinson Elizabeth J, Khosla Sundeep, Melton L Joseph
Division of Rheumatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA.
J Bone Miner Res. 2014 Mar;29(3):581-9. doi: 10.1002/jbmr.2072.
To assess recent trends in fracture incidence from all causes at all skeletal sites, we used the comprehensive (inpatient and outpatient) data resources of the Rochester Epidemiology Project to estimate rates for Olmsted County, MN, USA, residents in 2009 to 2011 compared with similar data from 1989 to 1991. During the 3-year study period, 2009 to 2011, 3549 residents ≥50 years of age experienced 5244 separate fractures. The age- and sex-adjusted (to the 2010 US white population) incidence of any fracture was 2704 per 100,000 person-years (95% confidence interval [CI] 2614 to 2793) and that for all fractures was 4017 per 100,000 (95% CI 3908 to 4127). Fracture incidence increased with age in both sexes, but age-adjusted rates were 49% greater among the women. Overall, comparably adjusted fracture incidence rates increased by 11% (from 3627 to 4017 per 100,000 person-years; p = 0.008) between 1989 to 1991 and 2009 to 2011. This was mainly attributable to a substantial increase in vertebral fractures (+47% for both sexes combined), which was partially offset by a decline in hip fractures (-25%) among the women. There was also a 26% reduction in distal forearm fractures among the women; an increase in distal forearm fractures among men aged 50 years and over was not statistically significant. The dramatic increase in vertebral fractures, seen in both sexes and especially after age 75 years, was attributable in part to incidentally diagnosed vertebral fractures. However, the fall in hip fracture incidence, observed in most age groups, continues the steady decline observed among women in this community since 1950. More generally, these data indicate that the dramatic increases in the incidence of fractures at many skeletal sites that were observed decades ago have now stabilized.
为评估所有骨骼部位各种原因导致的骨折发病率的近期趋势，我们利用罗切斯特流行病学项目的综合（住院和门诊）数据资源，估算了美国明尼苏达州奥尔姆斯特德县居民在2009年至2011年期间的骨折发病率，并与1989年至1991年的类似数据进行比较。在2009年至2011年这3年的研究期间，3549名年龄≥50岁的居民发生了5244例不同的骨折。经年龄和性别调整（以2010年美国白人人口为标准）后，任何骨折的发病率为每10万人年2704例（95%置信区间[CI]为2614至2793），所有骨折的发病率为每10万人年4017例（95%CI为3908至4127）。男女骨折发病率均随年龄增长而增加，但经年龄调整后的发病率女性比男性高49%。总体而言，在1989年至1991年与2009年至2011年期间，经类似调整后的骨折发病率上升了11%（从每10万人年3627例增至4017例；p = 0.008）。这主要归因于椎体骨折大幅增加（男女合计增加47%），而女性髋部骨折下降（-25%）部分抵消了这一增长。女性远端前臂骨折也减少了26%；50岁及以上男性远端前臂骨折的增加无统计学意义。男女尤其是75岁以后椎体骨折的显著增加部分归因于偶然诊断出的椎体骨折。然而，在大多数年龄组中观察到的髋部骨折发病率下降延续了自1950年以来该社区女性中观察到的稳步下降趋势。更普遍地说，这些数据表明几十年前在许多骨骼部位观察到的骨折发病率的急剧上升现在已经稳定下来。
