Pedersen A B, Baggesen L M, Ehrenstein V, Pedersen L, Lasgaard M, Mikkelsen E M
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
Public Health and Quality Improvement, Central Denmark Region, Region House Aarhus, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
Osteoporos Int. 2016 Jun;27(6):2035-45. doi: 10.1007/s00198-016-3490-1. Epub 2016 Jan 19.
Perceived stress is associated with several adverse health outcomes; however, little is known about the impact of stress on fracture risk. In this population-based cohort study, persons with high perceived stress have an increased 5-year risk of any osteoporotic fracture, in particular hip fracture.
We conducted a population-based cohort study in Denmark to examine the association between perceived stress and risk of subsequent osteoporotic fracture.
A 2006 population-based health survey in the Central Danish Region (with 1.25 million inhabitants) was used to identify 7943 persons who were 55 years or older on the survey date and completed the Perceived Stress Scale. Individuals were categorized into two groups: high level of stress and low level of stress (including no stress). We obtained information on all osteoporotic fractures through linkage to the Danish National Registry of Patients. We used Cox regression to compute hazard ratios (HRs) with 95 % confidence interval (CI) adjusted for a number of lifestyle factors, socioeconomic data, perceived general health, and prescription history, comparing high- and low-stress persons.
A total of 1799 persons (22.6 %) reported high level of perceived stress, whereas 6144 (77.4 %) reported low level or no stress. The 5-year risk of any osteoporotic fracture was 7.4 and 5.4 % in persons with high and low perceived stress, respectively, corresponding to adjusted HR of 1.37 (CI 1.00-1.89). The adjusted HR for hip fracture within 5 years associated with high perceived stress was 1.68 (CI 1.04-2.72). The associations weakened with increasing follow-up time.
Persons with high perceived stress have an increased risk of any osteoporotic fracture, in particular risk of hip fracture within 5 years of stress assessment even after adjusting for differences in lifestyle, comorbidities, osteoporosis presence, medication use, and socioeconomic status at the time of stress level evaluation. The association attenuated after longer follow-up time.
感知压力与多种不良健康后果相关；然而，关于压力对骨折风险的影响知之甚少。在这项基于人群的队列研究中，感知压力高的人发生任何骨质疏松性骨折的5年风险增加，尤其是髋部骨折。
我们在丹麦进行了一项基于人群的队列研究，以检验感知压力与随后发生骨质疏松性骨折风险之间的关联。
利用2006年丹麦中部地区（有125万居民）基于人群的健康调查，确定在调查日期时年龄在55岁及以上且完成感知压力量表的7943人。个体被分为两组：高压力水平和低压力水平（包括无压力）。通过与丹麦国家患者登记处的链接，我们获取了所有骨质疏松性骨折的信息。我们使用Cox回归计算风险比（HRs）以及95%置信区间（CI），并对一些生活方式因素、社会经济数据、感知的总体健康状况和用药史进行了调整，比较了高压力和低压力人群。
共有1799人（22.6%）报告感知压力水平高，而6144人（77.4%）报告低压力水平或无压力。感知压力高和低的人发生任何骨质疏松性骨折的5年风险分别为7.4%和5.4%，对应的调整后HR为1.37（CI 1.00 - 1.89）。与高感知压力相关的5年内髋部骨折的调整后HR为1.68（CI 1.04 - 2.72）。随着随访时间的增加，这种关联减弱。
即使在调整了压力水平评估时的生活方式、合并症、骨质疏松症存在情况、药物使用和社会经济状况的差异后，感知压力高的人发生任何骨质疏松性骨折的风险增加，尤其是在压力评估后5年内发生髋部骨折的风险增加。随访时间延长后，这种关联减弱。
