Bethel M, Weaver F M, Bailey L, Miskevics S, Svircev J N, Burns S P, Hoenig H, Lyles K, Carbone L D
Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA.
Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA, USA.
Osteoporos Int. 2016 Oct;27(10):3011-21. doi: 10.1007/s00198-016-3627-2. Epub 2016 May 26.
Clinical risk factors for fracture were explored among Veterans with a spinal cord injury. At the end of 11 years of follow-up, the absolute risk of fracture was approximately 20 %. Among the clinical and SCI-related factors explored, a prior history of fracture was strongly associated with incident fracture.
Few studies to date have comprehensively addressed clinical risk factors for fracture in persons with spinal cord injury (SCI). The purpose of this study was to identify risk factors for incident osteoporotic fractures in persons with a SCI that can be easily determined at the point of care.
The Veteran's Affairs Spinal Cord Dysfunction Registry, a national database of persons with a SCI, was used to examine clinical and SCI-related risk factors for fracture. Incident fractures were identified in a cohort of persons with chronic SCI, defined as SCI present for at least 2 years. Cox regression models were used to estimate the risk of incident fractures.
There were 22,516 persons with chronic SCI included in the cohort with 3365 incident fractures. The mean observational follow-up time for the overall sample was 6.2 years (median 6.0, IQR 2.9-11.0). The mean observational follow-up time for the fracture group was 3.9 years (median 3.3, IQR 1.4-6.1) and 6.7 years (median 6.7, IQR 3.1-11.0) for the nonfracture group. By the end of the study, which included predominantly older Veterans with a SCI observed for a relatively short period of time, the absolute (i.e., cumulative hazard) for incident fractures was 0.17 (95%CI 0.14-0.21). In multivariable analysis, factors associated with an increased risk of fracture included White race, traumatic etiology of SCI, paraplegia, complete extent of SCI, longer duration of SCI, use of anticonvulsants and opioids, prevalent fractures, and higher Charlson Comorbidity Indices. Women aged 50 and older were also at higher risk of sustaining an incident fracture at any time during the 11-year follow-up period.
There are multiple clinical and SCI-related risk factors which can be used to predict fracture in persons with a SCI. Clinicians should be particularly concerned about incident fracture risk in persons with a SCI who have had a previous fracture.
在脊髓损伤退伍军人中探索骨折的临床危险因素。在11年随访结束时，骨折的绝对风险约为20%。在探索的临床和与脊髓损伤相关的因素中，既往骨折史与新发骨折密切相关。
迄今为止，很少有研究全面探讨脊髓损伤（SCI）患者骨折的临床危险因素。本研究的目的是确定脊髓损伤患者新发骨质疏松性骨折的危险因素，这些因素在医疗护理点易于确定。
使用退伍军人事务部脊髓功能障碍登记处（一个全国性的脊髓损伤患者数据库）来检查骨折的临床和与脊髓损伤相关的危险因素。在一组慢性脊髓损伤患者中识别新发骨折，慢性脊髓损伤定义为脊髓损伤存在至少2年。使用Cox回归模型估计新发骨折的风险。
队列中纳入了22516例慢性脊髓损伤患者，其中3365例新发骨折。整个样本的平均观察随访时间为6.2年（中位数6.0，四分位间距2.9 - 11.0）。骨折组的平均观察随访时间为3.9年（中位数3.3，四分位间距1.4 - 6.1），非骨折组为6.7年（中位数6.7，四分位间距3.1 - 11.0）。在这项主要纳入年龄较大的脊髓损伤退伍军人且观察时间相对较短的研究结束时，新发骨折的绝对风险（即累积风险）为0.17（95%置信区间0.14 - 0.21）。在多变量分析中，与骨折风险增加相关的因素包括白人种族、脊髓损伤的创伤性病因、截瘫、脊髓损伤的完全程度、脊髓损伤持续时间更长、使用抗惊厥药和阿片类药物、既往骨折、以及更高的查尔森合并症指数。50岁及以上的女性在11年随访期间任何时候发生新发骨折的风险也更高。
有多种临床和与脊髓损伤相关的危险因素可用于预测脊髓损伤患者的骨折。临床医生应特别关注有既往骨折史的脊髓损伤患者的新发骨折风险。
