Saad Randa K, Harb Hilda, Bou-Orm Ibrahim R, Ammar Walid, El-Hajj Fuleihan Ghada
Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders at the American University of Beirut-Medical Center, Beirut, Lebanon.
Ministry of Public Health, Beirut, Lebanon.
J Bone Miner Res. 2020 Jan;35(1):71-80. doi: 10.1002/jbmr.3870. Epub 2019 Oct 14.
Country-specific hip fracture incidence rates (IRs) and longevity allow the Fracture Risk Assessment Tool (FRAX) to be adapted to individual countries. Secular trends can affect tool calibration. Data on hip fracture IRs in the Middle East is scarce, and long-term secular trend studies are nonexistent. Using the Ministry of Public Health hip fracture registry, we calculated age- and sex-specific hip fracture IRs in Lebanon, from 2006 to 2017, among individuals aged ≥50 years. We used Kendall's tau-b (τb) test to determine the correlation between time and hip fracture IRs, and calculated both the annual % change in IRs and the % change in IR compared to the baseline period (2006 to 2008). The registry recorded 6985 hip fractures, 74% at the femoral neck, 23% intertrochanteric, and 3% subtrochanteric. Men constituted 32% of the population, and were significantly younger than women (76.5 ± 11.0 years versus 77.7 ± 10.3 years; p < 0.001). Annual overall IRs, per 100,000, ranged from 126.6 in 2014 to 213.2 in 2017 in women, and 61.4 in 2015 to 111.7 in 2017 in men. The average women to men IR ratio was 1.8 (range, 1.5 to 2.1). IRs steadily increased with age, and IR ratios increased in parallel in both sexes, with a steeper and earlier rise (by 5 years) in women. Data showed a consistent decline in hip fracture IRs starting in 2006 in women, and in 2009 in men. There was a significant negative correlation between time (2006 to 2014) and hip fracture IRs in women (τb = -0.611, p = 0.022) but not in men (τb = -0.444, p = 0.095). The steady decrease in IRs reversed after 2015 in both sexes. This long-term data on secular trends in the Middle East is novel and consistent with worldwide changes in hip fracture rates. The impact of such changes on national FRAX-derived estimates is unclear, should be assessed, and may necessitate an update in the FRAX Lebanon calculator. © 2019 American Society for Bone and Mineral Research.
特定国家的髋部骨折发病率（IRs）和预期寿命使得骨折风险评估工具（FRAX）能够针对各个国家进行调整。长期趋势可能会影响工具校准。中东地区髋部骨折发病率的数据稀缺，且不存在长期趋势研究。利用公共卫生部的髋部骨折登记处，我们计算了2006年至2017年黎巴嫩≥50岁人群中按年龄和性别划分的髋部骨折发病率。我们使用肯德尔tau-b（τb）检验来确定时间与髋部骨折发病率之间的相关性，并计算发病率的年度变化百分比以及与基线期（2006年至2008年）相比发病率的变化百分比。登记处记录了6985例髋部骨折，其中74%发生在股骨颈，23%发生在转子间，3%发生在转子下。男性占人口的32%，且明显比女性年轻（76.5±11.0岁对77.7±10.3岁；p<0.001）。女性每10万人的年度总体发病率从2014年的126.6到2017年的213.2，男性从2015年的61.4到2017年的111.7。女性与男性的发病率平均比值为1.8（范围为1.5至2.1）。发病率随年龄稳步上升，且两性的发病率比值平行上升，女性上升更陡峭且更早（早5年）。数据显示，女性从2006年开始、男性从2009年开始髋部骨折发病率持续下降。在女性中，时间（2006年至2014年）与髋部骨折发病率之间存在显著负相关（τb = -0.611，p = 0.022），但在男性中不存在（τb = -0.444，p = 0.095）。2015年后，两性的发病率持续下降趋势逆转。中东地区这种长期趋势数据是新颖的，且与全球髋部骨折率变化一致。这种变化对基于国家FRAX得出的估计值的影响尚不清楚，应予以评估，且可能需要更新黎巴嫩的FRAX计算器。©2019美国骨与矿物质研究学会。
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