Division of Rheumatology, Department of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada.
Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie-CHUS), Sherbrooke, QC, Canada.
Calcif Tissue Int. 2018 Jul;103(1):62-70. doi: 10.1007/s00223-018-0393-5. Epub 2018 Jan 22.
While fragility fractures (FFs) are one of the strongest predictors of subsequent osteoporotic fractures, it remains unclear whether low-trauma ankle fractures have this ability. The aim of the study was to identify the characteristics of patients with low-trauma ankle FFs who develop subsequent FFs. The OPTIMUS initiative is a strategy to improve osteoporosis treatment post-FF in orthopedic clinics. FRAX scores without BMD (FRAX-BMI) were calculated at time of inclusion. Recurrent FFs were recorded over a 48-month follow-up. All FFs were X-ray-confirmed. A total of 265 patients with initial ankle FF were included (190 women; mean age 62.8 ± 9.6 years), of whom 15 developed new FFs. Patients with ankle FFs had longer time until recurrence and lower 2-year incidence of recurrent FFs (3.2%) compared with those having wrist FFs (9.0%) or other initial FFs (9.6%), and 4-year incidence rates of 6.2, 13.4, and 15.3%, respectively (log-rank test, p = 0.001). With an ankle FF at inclusion, recurrent FFs were more frequent in patients with previous FF (6.2 per 100 patient-years; p < 0.01) or high-risk FRAX-BMI scores pre- or post-FF (2.4 or 2.0 per 100 patient-years, respectively; ns), compared to patients without any of these conditions (0.7 per 100 patient-years). Ankle FFs represent a clinical opportunity for identifying at-risk patients who should be targeted for treatment (previous FFs and/or high-risk FRAX). Because of mechanical factors and other contributors involved, ankle FFs themselves do not predict subsequent FFs overall, and their inclusion in FRAX-BMI risk calculation may thus not be warranted.
虽然脆性骨折（FFs）是预测后续骨质疏松性骨折最强的指标之一，但低创伤性踝关节骨折是否具有这种能力尚不清楚。本研究的目的是确定发生后续 FF 的低创伤性踝关节 FF 患者的特征。OPTIMUS 倡议是一种在矫形诊所中改善 FF 后骨质疏松症治疗的策略。在纳入时计算无 BMD 的 FRAX 评分（FRAX-BMI）。在 48 个月的随访期间记录复发性 FF。所有 FF 均经 X 射线证实。共纳入 265 例初次踝关节 FF 患者（190 例女性；平均年龄 62.8±9.6 岁），其中 15 例发生新的 FF。与腕部 FF（9.0%）或其他初始 FF（9.6%）相比，踝关节 FF 患者的复发时间更长，2 年复发率较低（3.2%），4 年复发率分别为 6.2%、13.4%和 15.3%（对数秩检验，p=0.001）。纳入时存在踝关节 FF，既往有 FF（每 100 患者年 6.2 例；p<0.01）或 FF 前后高危 FRAX-BMI 评分（每 100 患者年分别为 2.4 或 2.0 例；ns）的患者中，复发性 FF 更为常见，与无上述任何情况的患者（每 100 患者年 0.7 例）相比。踝关节 FF 为识别高危患者提供了临床机会，应针对这些患者进行治疗（既往有 FF 和/或高危 FRAX）。由于机械因素和其他相关因素，踝关节 FF 本身并不能总体预测随后的 FF，因此其纳入 FRAX-BMI 风险计算可能没有必要。
