McMaster University, Hamilton, ON, Canada.
Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Osteoporos Int. 2020 Jun;31(6):1145-1153. doi: 10.1007/s00198-020-05330-2. Epub 2020 Feb 7.
We examined the underlying relationship between fracture risk factors and their imminent risk. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher imminent fracture risk. Past year falls indirectly predicted imminent risk through physical functioning and general health.
This study aimed to examine direct and indirect effects of several factors on imminent (1 year) fracture risk.
Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI).
The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001).
We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.
本研究旨在检验几种因素对即刻（1 年）骨折风险的直接和间接影响。
使用来自基于人群的加拿大骨质疏松症多中心研究中年龄在 65 岁及以上的女性数据。预测因子来自研究第 5 年和第 10 年，即刻骨折数据（1 年骨折）来自第 6 年和第 11 年（第 5 年预测第 6 年，第 10 年预测第 11 年）。使用结构方程模型（SEM）来检验理论结构。使用 36 项简短健康调查（SF-36）中的项目来衡量总体健康状况和身体机能，将其作为潜在变量，基于观察到的特定部位骨密度（脊柱 L1-L4、股骨颈、全髋）的 BMD T 评分是一个潜在变量。观察变量为骨折和跌倒。使用近似均方根误差（RMSEA）、塔克-刘易斯指数（TLI）和比较拟合指数（CFI）评估模型拟合度。
分析包括 3298 名女性。模型拟合检验表明，SEM 很好地拟合了数据；χ²（172）=1122.10<0.001，RMSEA=0.03，TLI=0.99，CFI=0.99。结果表明，过去一年发生骨折、过去一年总体健康状况较差、过去一年身体机能较差以及过去一年 BMD T 评分较低均直接预测随后一年骨折风险增加（p<0.001）。过去一年的跌倒通过身体机能和总体健康状况对即刻骨折风险具有统计学上显著但间接的影响（p<0.001）。
我们发现了一些直接和间接的途径，可以预测老年女性的即刻骨折风险。未来的研究应通过开发风险评分方法和确定即刻风险阈值来扩展这项工作。
