MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Calcif Tissue Int. 2020 Jun;106(6):625-636. doi: 10.1007/s00223-020-00680-9. Epub 2020 Mar 5.
The purpose of this study is to examine correlates of self-perceived fracture risk (SPR) and relationships between SPR and subsequent bone density and microarchitecture in the UK arm of the Global Longitudinal Study of Osteoporosis in Women. 3912 women completed baseline questionnaires detailing medical history and SPR; 492 underwent HRpQCT scans of the radius and tibia and DXA scans of total body, hip, femoral neck and lumbar spine a median of 7.5 years later. Correlates of SPR were examined and a cluster analysis of potential predictors of SPR performed. SPR in relation to HRpQCT and aBMD parameters was examined using linear regression with and without adjustment for anthropometric, demographic and lifestyle covariates. Mean (SD) baseline age was 69.0 (9.0) years; 56.6% reported a similar SPR; 28.6% lower SPR; 14.9% higher SPR compared to women of similar age. In mutually-adjusted analysis, higher SPR was associated (p < 0.05) with: lower physical activity and educational attainment; use of anti-osteoporosis medications (AOM) and calcium supplements; greater number of falls in the previous year; history of fracture since aged 45; family history of hip fracture; and increased comorbidity. Higher SPR, history of fracture, and use of AOM, calcium and vitamin D clustered together. Even after adjustments that included AOM use, higher SPR was associated with: lower radial trabecular volumetric density and number, and higher trabecular separation; lower tibial cortical area and trabecular volumetric density; and lower aBMD at the femoral neck. Despite greater AOM use, women with higher baseline SPR had poorer subsequent bone health.
本研究旨在探讨自我感知骨折风险（SPR）的相关因素，以及 SPR 与英国全球骨质疏松女性纵向研究（Global Longitudinal Study of Osteoporosis in Women）中随后的骨密度和微结构之间的关系。3912 名女性完成了基线问卷，详细描述了病史和 SPR；其中 492 名女性在中位时间为 7.5 年后接受了桡骨和胫骨 HRpQCT 扫描以及全身、髋部、股骨颈和腰椎 DXA 扫描。研究人员检查了 SPR 的相关因素，并对 SPR 的潜在预测因素进行了聚类分析。使用线性回归，分别在调整和不调整人体测量学、人口统计学和生活方式协变量的情况下，检查了 SPR 与 HRpQCT 和 aBMD 参数之间的关系。基线时年龄的平均值（标准差）为 69.0（9.0）岁；56.6%的女性报告 SPR 相似；28.6%的女性报告 SPR 较低；14.9%的女性报告 SPR 较高，与年龄相似的女性相比。在相互调整分析中，更高的 SPR 与（p<0.05）以下因素相关：较低的体力活动和教育程度；使用抗骨质疏松药物（AOM）和钙补充剂；前一年跌倒次数较多；45 岁以后骨折史；髋部骨折家族史；以及合并症增加。更高的 SPR、骨折史和使用 AOM、钙和维生素 D 聚集在一起。即使在包括 AOM 使用的调整后，更高的 SPR 与以下因素相关：桡骨小梁体积密度和数量较低，小梁分离度较高；胫骨皮质面积和小梁体积密度较低；股骨颈处 aBMD 较低。尽管 AOM 使用更多，但 SPR 基线较高的女性随后的骨健康状况更差。
