MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
J Bone Miner Res. 2018 Mar;33(3):510-516. doi: 10.1002/jbmr.3331. Epub 2017 Dec 8.
Although prior falls are a well-established predictor of future fracture, there is currently limited evidence regarding the specific value of falls history in fracture risk assessment relative to that of other clinical risk factors and bone mineral density (BMD) measurement. We therefore investigated, across the three Osteoporotic Fractures in Men (MrOS) Study cohorts, whether past falls predicted future fracture independently of FRAX and whether these associations varied with age and follow-up time. Elderly men were recruited from MrOS Sweden, Hong Kong, and USA. Baseline data included falls history (over the preceding 12 months), clinical risk factors, BMD at femoral neck, and calculated FRAX probabilities. An extension of Poisson regression was used to investigate the associations between falls, FRAX probability, and incident fracture, adjusting for age, time since baseline, and cohort in base models; further models were used to investigate interactions with age and follow-up time. Random-effects meta-analysis was used to synthesize the individual country associations. Information on falls and FRAX probability was available for 4365 men in USA (mean age 73.5 years; mean follow-up 10.8 years), 1823 men in Sweden (mean age 75.4 years; mean follow-up 8.7 years), and 1669 men in Hong Kong (mean age 72.4 years; mean follow-up 9.8 years). Rates of past falls were similar at 20%, 16%, and 15%, respectively. Across all cohorts, past falls predicted incident fracture at any site (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 1.49, 1.90), major osteoporotic fracture (MOF) (HR = 1.56; 95% CI 1.33, 1.83), and hip fracture (HR = 1.61; 95% CI 1.27, 2.05). Relationships between past falls and incident fracture remained robust after adjustment for FRAX probability: adjusted HR (95% CI) any fracture: 1.63 (1.45, 1.83); MOF: 1.51 (1.32, 1.73); and hip: 1.54 (1.21, 1.95). In conclusion, past falls predicted incident fracture independently of FRAX probability, confirming the potential value of falls history in fracture risk assessment. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
尽管先前的跌倒已被确立为未来骨折的预测指标，但目前关于跌倒史在骨折风险评估中的具体价值相对于其他临床危险因素和骨密度（BMD）测量的证据有限。因此，我们在三个男性骨质疏松性骨折研究队列中进行了研究，即在不考虑 FRAX 和年龄及随访时间的情况下，过去的跌倒是否独立预测未来骨折，以及这些关联是否存在差异。从 MrOS 瑞典、中国香港和美国招募了老年男性。基线数据包括过去 12 个月的跌倒史、临床危险因素、股骨颈 BMD 和计算的 FRAX 概率。使用泊松回归扩展来研究跌倒、FRAX 概率与新发骨折之间的关联，在基本模型中调整年龄、基线后时间和队列；进一步的模型用于研究与年龄和随访时间的相互作用。使用随机效应荟萃分析综合了个别国家的关联。在美国（平均年龄 73.5 岁；平均随访 10.8 年）、瑞典（平均年龄 75.4 岁；平均随访 8.7 年）和中国香港（平均年龄 72.4 岁；平均随访 9.8 年）的 4365 名男性、1823 名男性和 1669 名男性中可获得有关跌倒和 FRAX 概率的信息。过去跌倒的发生率分别为 20%、16%和 15%，相似。在所有队列中，过去的跌倒均预测任何部位的新发骨折（危险比 [HR] = 1.69；95%置信区间 [CI] 1.49，1.90）、主要骨质疏松性骨折（MOF）（HR = 1.56；95% CI 1.33，1.83）和髋部骨折（HR = 1.61；95% CI 1.27，2.05）。在调整 FRAX 概率后，过去跌倒与新发骨折之间的关系仍然稳健：调整后的 HR（95%CI）任何骨折：1.63（1.45，1.83）；MOF：1.51（1.32，1.73）；髋部骨折：1.54（1.21，1.95）。总之，过去的跌倒独立于 FRAX 概率预测新发骨折，证实了跌倒史在骨折风险评估中的潜在价值。© 2017 作者。《骨与矿物研究杂志》由 Wiley 期刊出版公司出版。
