Yoshii Ichiro, Chijiwa Tatsumi, Sawada Naoya, Kokei Shohei
Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, Shimanto City, 787-0033, Kochi Prefecture, Japan.
Department of Rheumatology, Kochi Memorial Hospital, Kochi, 780-0824, Kochi Prefecture, Japan.
Osteoporos Sarcopenia. 2021 Sep;7(3):115-120. doi: 10.1016/j.afos.2021.09.004. Epub 2021 Sep 17.
Influence of presenting musculoskeletal ambulation disability symptom complex (MADS) on occurrence of bone fragility fracture (BFF) is investigated with retrospective cohort study.
A total of 931 subjects joined in the study. Subjects were selected as bone fragility risk positive in the fracture assessment tool questionnaire. Their assumed risk factors were harvested from the medical records and X-ray pictures. They were followed up at least 8 years consecutively, and occurrence of incident BFF was set as primary endpoint. Each assumed risk factor including MADS was evaluated using Cox regression analysis. Subjects were divided into 2 groups according to presence of MADS (G-MADS and G-noMADS). Adjusted hazard ratios between the 2 groups was evaluated using Cox regression analysis. The statistical procedures were performed before and after propensity score matching (PSM) procedures in order to make parallel with assumed risk factors.
Statistically significant risk factors within 5% were prevalent vertebral body fracture, disuse, MADS, cognitive disorder, hypertension, contracture, Parkinsonism, being female sex, hyperlipidemia, insomnia, T-score in the femoral neck ≤ -2.3, chronic kidney disease ≥ stage 2, chronic obstructive pulmonary diseases, glucocorticoid steroid administrated, and osteoarthritis in order of the adjusted hazard ratios (from highest to lowest). Adjusted hazard ratios between G-MADS and G-noMADS were 2.70 and 1.83 for before and after PSM, respectively.
MADS demonstrated as a significant risk factor of BFF occurrence. In treating osteoporosis, fall risk should be aware of as well as bone fragility risk.
采用回顾性队列研究调查肌肉骨骼行走功能障碍症状复合体（MADS）对脆性骨折（BFF）发生的影响。
共有931名受试者参与本研究。通过骨折评估工具问卷将受试者选为脆性骨折风险阳性。从病历和X光片中收集他们假定的风险因素。对他们进行至少8年的连续随访，将新发BFF的发生作为主要终点。使用Cox回归分析评估包括MADS在内的每个假定风险因素。根据MADS的存在情况将受试者分为两组（MADS组和无MADS组）。使用Cox回归分析评估两组之间的调整后风险比。为了使假定风险因素具有可比性，在倾向得分匹配（PSM）程序前后进行统计程序。
5%以内具有统计学意义的风险因素依次为椎体骨折、废用、MADS、认知障碍、高血压、挛缩、帕金森病、女性、高脂血症、失眠、股骨颈T值≤-2.3、慢性肾病≥2期、慢性阻塞性肺疾病、使用糖皮质激素和骨关节炎（按调整后风险比从高到低排列）。PSM前后MADS组和无MADS组之间的调整后风险比分别为2.70和1.83。
MADS被证明是BFF发生的一个重要风险因素。在治疗骨质疏松症时，应同时关注跌倒风险和骨脆性风险。
