Lam Anna, Leslie William D, Lix Lisa M, Yogendran Marina, Morin Suzanne N, Majumdar Sumit R
University of Manitoba, Winnipeg, Canada.
J Bone Miner Res. 2014;29(5):1067-73. doi: 10.1002/jbmr.2146.
Fracture Risk Assessment (FRAX) tools are calibrated from country-specific fracture epidemiology. Although hip fracture data are usually available, data on non-hip fractures for most countries are often lacking. In such cases, rates are often estimated by assuming similar non-hip to hip fracture ratios from historical (1987 to 1996) Swedish data. Evidence that countries share similar fracture ratios is limited. Using data from Manitoba, Canada (2000 to 2007, population 1.2 million), we identified 21,850 incident major osteoporotic fractures (MOF) in men and women aged >50 years. Population-based age- and sex-specific ratios of clinical vertebral, forearm, and humerus fractures to hip fractures were calculated, along with odds ratios (ORs) and 95% confidence intervals (CIs). All ratios showed decreasing trends with increasing age for both men and women. Men and women showed similar vertebral/hip fracture ratios (all p > 0.1, with ORs 0.86 to 1.25). Forearm/hip and humerus/hip fracture ratios were significantly lower among men than women (forearm/hip ratio: p < 0.01 for all age groups, with ORs 0.29 to 0.53; humerus/hip ratio: p < 0.05 for all age groups [except 80 to 84 years] with ORs 0.46 to 0.86). Ratios for any MOF/hip fracture were also significantly lower among men than women in all but two subgroups (p < 0.05 for all age groups [except 80 to 84 and 90+ years] with ORs 0.48 to 0.87). Swedish vertebral/hip fracture ratios were similar to the Canadian fracture ratios (within 7%) but significantly lower for other sites (men and women: 46% and 35% lower for forearm/hip ratios, 19% and 15% lower for humerus/hip ratios, and 19% and 23% lower for any MOF/hip ratios). These differences have implications for updating and calibrating FRAX tools, fracture risk estimation, and intervention rates. Moreover, wherever possible, it is important that countries try to collect accurate non-hip fracture data.
骨折风险评估（FRAX）工具是根据特定国家的骨折流行病学进行校准的。虽然髋部骨折数据通常可得，但大多数国家的非髋部骨折数据往往缺失。在这种情况下，通常通过假设与历史（1987年至1996年）瑞典数据中相似的非髋部与髋部骨折比例来估计发生率。各国骨折比例相似的证据有限。利用加拿大曼尼托巴省（2000年至2007年，人口120万）的数据，我们在50岁以上的男性和女性中确定了21,850例新发的主要骨质疏松性骨折（MOF）。计算了基于人群的年龄和性别特异性的临床椎体、前臂和肱骨骨折与髋部骨折的比例，以及优势比（OR）和95%置信区间（CI）。所有比例在男性和女性中均显示出随年龄增长而下降的趋势。男性和女性的椎体/髋部骨折比例相似（所有p>0.1，OR为0.86至1.25）。男性的前臂/髋部和肱骨/髋部骨折比例显著低于女性（前臂/髋部比例：所有年龄组p<0.01，OR为0.29至0.53；肱骨/髋部比例：除80至84岁年龄组外，所有年龄组p<0.05，OR为0.46至0.86）。除两个亚组外，男性中任何MOF/髋部骨折的比例也显著低于女性（所有年龄组p<0.05，除80至84岁和90岁以上年龄组外，OR为0.48至0.87）。瑞典的椎体/髋部骨折比例与加拿大的骨折比例相似（在7%以内），但其他部位的比例显著较低（男性和女性：前臂/髋部比例分别低46%和35%，肱骨/髋部比例分别低19%和15%，任何MOF/髋部比例分别低19%和23%）。这些差异对更新和校准FRAX工具、骨折风险估计和干预率有影响。此外，只要有可能，各国努力收集准确的非髋部骨折数据很重要。
