Department of Community Health Sciences, University of Manitoba, 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China.
Osteoporos Int. 2021 Apr;32(4):681-688. doi: 10.1007/s00198-020-05635-2. Epub 2020 Sep 15.
We investigated the association of objectively ascertained sibling fracture history with major osteoporotic fracture (hip, forearm, humerus, or clinical spine) risk in a population-based cohort using administrative databases. Sibling fracture history is associated with increased major osteoporotic fracture risk, which has implications for fracture risk prediction.
We aimed to determine whether objectively ascertained sibling fracture history is associated with major osteoporotic fracture (MOF; hip, forearm, humerus, or clinical spine) risk.
This retrospective cohort study used administrative databases from the province of Manitoba, Canada, which has a universal healthcare system. The cohort included men and women 40+ years between 1997 and 2015 with linkage to at least one sibling. The exposure was sibling MOF diagnosis occurring after age 40 years and prior to the outcome. The outcome was incident MOF identified in hospital and physician records using established case definitions. A multivariable Cox proportional hazards regression model was used to estimate the risk of MOF after adjustment for known fracture risk factors.
The cohort included 217,527 individuals; 91.9% were linked to full siblings (siblings having the same father and mother) and 49.0% were females. By the end of the study period, 6255 (2.9%) of the siblings had a MOF. During a median follow-up of 11 years (IQR 5-15), 5235 (2.4%) incident MOF were identified in the study cohort, including 234 hip fractures. Sibling MOF history was associated with an increased risk of MOF (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.44-1.92). The risk was elevated in both men (HR 1.57, 95% CI 1.24-1.98) and women (HR 1.74, 95% CI 1.45-2.08). The highest risk was associated with a sibling diagnosis of forearm fracture (HR 1.81, 95% CI 1.53-2.15).
Sibling fracture history is associated with increased MOF risk and should be considered as a candidate risk factor for improving fracture risk prediction.
本研究旨在确定通过客观手段确定的同胞骨折史是否与主要骨质疏松性骨折（MOF；髋部、前臂、肱骨或临床脊柱）风险相关。
这是一项回顾性队列研究，使用了加拿大马尼托巴省的行政数据库，该省拥有全民医疗保健系统。该队列纳入了 1997 年至 2015 年间 40 岁以上的男性和女性，且至少与一名同胞有联系。暴露因素为 40 岁后至发病前同胞发生的 MOF 诊断。通过既定的病例定义，在医院和医生记录中确定 MOF 的发病情况。采用多变量 Cox 比例风险回归模型，在调整已知骨折风险因素后，估计 MOF 的发病风险。
该队列包括 217527 人；91.9%与同胞（具有相同父母的兄弟姐妹）有联系，49.0%为女性。在研究结束时，6255 名（2.9%）同胞发生了 MOF。在中位随访 11 年（IQR 5-15）期间，研究队列中确定了 5235 例（2.4%）新发 MOF，包括 234 例髋部骨折。同胞 MOF 史与 MOF 发病风险增加相关（风险比 [HR] 1.67，95%置信区间 [CI] 1.44-1.92）。男性（HR 1.57，95% CI 1.24-1.98）和女性（HR 1.74，95% CI 1.45-2.08）的风险均升高。与同胞前臂骨折诊断相关的风险最高（HR 1.81，95% CI 1.53-2.15）。
同胞骨折史与 MOF 发病风险增加相关，应考虑将其作为改善骨折风险预测的候选风险因素。
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