MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
J Bone Miner Res. 2021 Apr;36(4):654-661. doi: 10.1002/jbmr.4239. Epub 2021 Jan 28.
In the Women's Health Initiative (WHI), we investigated associations between baseline dual-energy X-ray absorptiometry (DXA) appendicular lean mass (ALM) and risk of incident fractures, falls, and mortality (separately for each outcome) among older postmenopausal women, accounting for bone mineral density (BMD), prior falls, and Fracture Risk Assessment Tool (FRAX ) probability. The WHI is a prospective study of postmenopausal women undertaken at 40 US sites. We used an extension of Poisson regression to investigate the relationship between baseline ALM (corrected for height ) and incident fracture outcomes, presented here for major osteoporotic fracture (MOF: hip, clinical vertebral, forearm, or proximal humerus), falls, and death. Associations were adjusted for age, time since baseline and randomization group, or additionally for femoral neck (FN) BMD, prior falls, or FRAX probability (MOF without BMD) and are reported as gradient of risk (GR: hazard ratio for first incident fracture per SD increment) in ALM/height (GR). Data were available for 11,187 women (mean [SD] age 63.3 [7.4] years). In the base models (adjusted for age, follow-up time, and randomization group), greater ALM/height was associated with lower risk of incident MOF (GR = 0.88; 95% confidence interval [CI] 0.83-0.94). The association was independent of prior falls but was attenuated by FRAX probability. Adjustment for FN BMD T-score led to attenuation and inversion of the risk relationship (GR = 1.06; 95% CI 0.98-1.14). There were no associations between ALM/height and incident falls. However, there was a 7% to 15% increase in risk of death during follow-up for each SD greater ALM/height , depending on specific adjustment. In WHI, and consistent with our findings in older men (Osteoporotic Fractures in Men [MrOS] study cohorts), the predictive value of DXA-ALM for future clinical fracture is attenuated (and potentially inverted) after adjustment for femoral neck BMD T-score. However, intriguing positive, but modest, associations between ALM/height and mortality remain robust. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
在妇女健康倡议（WHI）中，我们研究了基线双能 X 射线吸收法（DXA）四肢瘦体重（ALM）与老年绝经后女性骨折、跌倒和死亡率（分别针对每种结局）之间的关系，同时考虑了骨密度（BMD）、既往跌倒和骨折风险评估工具（FRAX）概率。WHI 是一项在美国 40 个地点进行的绝经后妇女前瞻性研究。我们使用泊松回归的扩展来研究基线 ALM（按身高校正）与骨折事件的关系，这里为主要骨质疏松性骨折（MOF：髋部、临床椎体、前臂或近端肱骨）、跌倒和死亡呈列。关联调整了年龄、从基线和随机分组开始的时间，或者还调整了股骨颈（FN）BMD、既往跌倒或 FRAX 概率（无 BMD 的 MOF），并报告为 ALM/身高的风险梯度（GR：SD 每增加一个单位，首次骨折的风险比）（GR）。有 11187 名女性（平均[标准差]年龄 63.3[7.4]岁）的数据可用。在基础模型中（调整了年龄、随访时间和随机分组），更高的 ALM/身高与较低的 MOF 风险相关（GR = 0.88；95%置信区间[CI]为 0.83-0.94）。该关联独立于既往跌倒，但受 FRAX 概率的影响。调整 FN BMD T 评分会导致风险关系减弱和反转（GR = 1.06；95%CI 为 0.98-1.14）。ALM/身高与跌倒无关。然而，在随访期间，ALM/身高每增加一个 SD，死亡风险增加 7%至 15%，具体取决于特定调整。在 WHI 中，与我们在老年男性（男性骨质疏松性骨折[MrOS]研究队列）中的发现一致，DXA-ALM 对未来临床骨折的预测价值在调整股骨颈 BMD T 评分后减弱（并可能反转）。然而，ALM/身高与死亡率之间仍存在有趣的、适度的正相关关系，这一关系仍然稳健。2021 年，作者。骨质研究杂志由 Wiley 期刊出版公司代表美国骨与矿物研究协会（ASBMR）出版。
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