Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA.
Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY, USA.
J Bone Miner Res. 2015 Nov;30(11):2086-95. doi: 10.1002/jbmr.2559. Epub 2015 Jun 12.
Wrist fractures are common in postmenopausal women and are associated with functional decline. Fracture patterns after wrist fracture are unclear. The goal of this study was to determine the frequency and types of fractures that occur after a wrist fracture among postmenopausal women. We carried out a post hoc analysis of data from the Women's Health Initiative Observational Study and Clinical Trials (1993-2010) carried out at 40 US clinical centers. Participants were postmenopausal women aged 50 to 79 years at baseline. Mean follow-up duration was 11.8 years. Main measures included incident wrist, clinical spine, humerus, upper extremity, lower extremity, hip, and total non-wrist fractures and bone mineral density (BMD) in a subset. Among women who experienced wrist fracture, 15.5% subsequently experienced non-wrist fracture. The hazard for non-wrist fractures was higher among women who had experienced previous wrist fracture than among women who had not experienced wrist fracture: non-wrist fracture overall (hazard ratio [HR] = 1.40, 95% confidence interval [CI] 1.33-1.48), spine (HR = 1.48, 95% CI 1.32-1.66), humerus (HR = 1.78, 95% CI 1.57-2.02), upper extremity (non-wrist) (HR = 1.88, 95% CI 1.70-2.07), lower extremity (non-hip) (HR = 1.36, 95% CI 1.26-1.48), and hip (HR = 1.50, 95% CI 1.32-1.71) fracture. Associations persisted after adjustment for BMD, physical activity, and other risk factors. Risk of non-wrist fracture was higher in women who were younger when they experienced wrist fracture (interaction p value 0.02). Associations between incident wrist fracture and subsequent non-wrist fracture did not vary by baseline BMD category (normal, low bone density, osteoporosis). A wrist fracture is associated with increased risk of subsequent hip, vertebral, upper extremity, and lower extremity fractures. There may be substantial missed opportunity for intervention in the large number of women who present with wrist fractures.
腕部骨折在绝经后妇女中很常见,与功能下降有关。腕部骨折后的骨折模式尚不清楚。本研究的目的是确定绝经后妇女腕部骨折后发生骨折的频率和类型。我们对 40 个美国临床中心进行的妇女健康倡议观察研究和临床试验(1993-2010 年)的数据进行了事后分析。参与者为基线时年龄在 50 至 79 岁的绝经后妇女。平均随访时间为 11.8 年。主要测量指标包括腕部、临床脊柱、肱骨、上肢、下肢、髋部和非腕部骨折以及亚组骨密度(BMD)的发生率。在经历过腕部骨折的女性中,有 15.5%随后发生了非腕部骨折。与未经历过腕部骨折的女性相比,经历过先前腕部骨折的女性发生非腕部骨折的风险更高:非腕部骨折总发生率(危险比[HR] = 1.40,95%置信区间[CI] 1.33-1.48)、脊柱(HR = 1.48,95% CI 1.32-1.66)、肱骨(HR = 1.78,95% CI 1.57-2.02)、上肢(非腕部)(HR = 1.88,95% CI 1.70-2.07)、下肢(非髋部)(HR = 1.36,95% CI 1.26-1.48)和髋部(HR = 1.50,95% CI 1.32-1.71)骨折。调整 BMD、体力活动和其他危险因素后,相关性仍然存在。在经历腕部骨折时年龄较小的女性中,非腕部骨折的风险更高(交互 p 值 0.02)。腕部骨折与随后发生的非腕部骨折之间的关联不因基线 BMD 类别(正常、低骨密度、骨质疏松症)而异。腕部骨折与随后发生髋部、椎体、上肢和下肢骨折的风险增加有关。在大量出现腕部骨折的女性中,存在大量错失干预的机会。