Crandall Carolyn J, Hunt Rebecca P, LaCroix Andrea Z, Robbins John A, Wactawski-Wende Jean, Johnson Karen C, Sattari Maryam, Stone Katie L, Weitlauf Julie C, Gure Tanya R, Cauley Jane A
Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 1100 Glendon Ave. Suite 850 - Room 858, Los Angeles, CA 90024, United States.
WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
EClinicalMedicine. 2021 May 5;35:100826. doi: 10.1016/j.eclinm.2021.100826. eCollection 2021 May.
BACKGROUND: The locations of subsequent fractures after initial fracture in postmenopausal women are poorly characterized. METHODS: We conducted a prospective analysis of subsequent fractures after initial fracture in Women's Health Initiative (1993-2018) participants who provided follow-up (mean 15.4 years, SD 6.2 years) data ( = 157,282 participants; baseline age 50-79; 47,458 participants with incident fracture). Cox proportional hazards models were adjusted for age, race/ethnicity, body mass index, and other covariates. FINDINGS: The risk of each type of subsequent fracture was increased after each type of initial fracture. Incident lower arm/wrist fracture was associated with significantly elevated risks of subsequent fractures at the upper arm/shoulder, upper leg, knee, lower leg/ankle, hip/pelvis, and spine (adjusted hazard ratios [aHRs] ranging 2·63-5·68). The risk of hip fracture was increased after initial lower arm or wrist fracture (aHR 4·80, 95% CI 4·29-5·36), initial upper arm or shoulder fracture (aHR 5·06, 95% CI 4·39-5·82), initial upper leg fracture (aHR 5·11, 95% CI 3·91-6·67), initial knee fracture (aHR 5·03, 95% CI 4·20-6·03), initial lower leg/ankle fracture (aHR 4·10, 95% CI 3·58-4·68), and initial spine fracture (aHR 6·69, 95% CI 5·95-7·53). Associations were significant in all age groups, even women aged 50-59 years. Risks of subsequent fracture were more pronounced among non-Hispanic Black, Hispanic/Latina, and Asian/Pacific Islander than among non-Hispanic White women. INTERPRETATION: Increased risk of subsequent fracture is observed for all fracture types across all ages. Women who experience any of these fractures should be targeted for interventions to prevent subsequent fractures. FUNDING: National Institutes of Health HHSN268201600018C,HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.
背景:绝经后女性初次骨折后再次骨折的部位特征尚不明确。 方法:我们对女性健康倡议(1993 - 2018年)参与者初次骨折后的再次骨折情况进行了前瞻性分析,这些参与者提供了随访数据(平均15.4年,标准差6.2年)(n = 157,282名参与者;基线年龄50 - 79岁;47,458名发生过骨折的参与者)。Cox比例风险模型对年龄、种族/族裔、体重指数和其他协变量进行了调整。 研究结果:每种类型的初次骨折后,每种类型的再次骨折风险都会增加。初次发生前臂/腕部骨折与上臂/肩部、大腿、膝盖、小腿/脚踝、髋部/骨盆和脊柱随后发生骨折的风险显著升高相关(调整后风险比[aHRs]范围为2.63 - 5.68)。初次发生前臂或腕部骨折后髋部骨折风险增加(aHR 4.80,95%置信区间4.29 - 5.36),初次发生上臂或肩部骨折后(aHR 5.06,95%置信区间4.39 - 5.82),初次发生大腿骨折后(aHR 5.11,95%置信区间3.91 - 6.67),初次发生膝盖骨折后(aHR 5.03,95%置信区间4.20 - 6.03),初次发生小腿/脚踝骨折后(aHR 4.10,95%置信区间3.58 - 4.68),以及初次发生脊柱骨折后(aHR 6.69,95%置信区间5.95 - 7.53)。在所有年龄组中关联均显著,即使是50 - 59岁的女性。非西班牙裔黑人、西班牙裔/拉丁裔和亚裔/太平洋岛民女性再次骨折的风险比非西班牙裔白人女性更明显。 解读:在所有年龄段,所有骨折类型的再次骨折风险均有所增加。经历过这些骨折中的任何一种的女性都应成为预防再次骨折干预措施的目标对象。 资助:美国国立卫生研究院HHSN268201600018C、HHSN268201600001C、HHSN268201600002C、HHSN268201600003C和HHSN268201600004C。
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