Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
Faculty of Medicine, UNSW Sydney, Sydney, Australia.
J Bone Miner Res. 2022 Aug;37(8):1571-1579. doi: 10.1002/jbmr.4619. Epub 2022 Jul 6.
Muscle strength and physical performance are associated with incident fractures and mortality. However, their role in the risk of subsequent fracture and postfracture mortality is not clear. We assessed the association between muscle strength (grip strength) and performance (gait speed and chair stands time) and the risk of subsequent fracture and mortality in 830 men with low-trauma index fracture, who participated in the Osteoporotic Fractures in Men (MrOS) USA Study and had their index measurements assessed within 5 years prior to the index fracture. The annual decline in muscle strength and performance following index fracture, estimated using linear mixed-effects regression, was also examined in relation to mortality. The associations were assessed using Cox proportional hazards models adjusted for age, femoral neck bone mineral density (FN BMD), prior fractures, falls, body mass index (BMI), index fracture site, lifestyle factors, and comorbidities. Over a median follow-up of 3.7 (interquartile range [IQR], 1.3-8.1) years from index fracture to subsequent fracture, 201 (24%) men had a subsequent fracture and over 5.1 (IQR, 1.8-9.6) years to death, and 536 (65%) men died. Index measurements were not associated with subsequent fracture (hazard ratios [HRs] ranging from 0.97 to 1.07). However, they were associated with postfracture mortality. HR (95% confidence interval [CI]) per 1 standard deviation (1-SD) decrement in grip strength: HR 1.12 (95% CI, 1.01-1.25) and gait speed: HR 1.14 (95% CI, 1.02-1.27), and 1-SD increment in chair stands time: HR 1.08 (95% CI, 0.97-1.21). Greater annual declines in these measurements were associated with higher mortality risk, independent of the index values and other covariates. HR (95% CI) per 1-SD annual decrement in change in grip strength: HR 1.15 (95% CI, 1.01-1.33) and in gait speed: HR 1.38 (95% CI, 1.13-1.68), and 1-SD annual increment in chair stands time: HR 1.28 (95% CI, 1.07-1.54). Men who were unable to complete one or multiple tests had greater risk of postfracture mortality (24%-109%) compared to those performed all tests. It remains to be seen whether improvement in these modifiable factors can reduce postfracture mortality. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
肌肉力量和身体表现与骨折事件和死亡率有关。然而，它们在随后骨折和骨折后死亡率风险中的作用尚不清楚。我们评估了 830 名低创伤指数骨折男性的肌肉力量（握力）和表现（步态速度和坐站时间）与随后骨折和死亡率风险之间的关联，这些男性参加了男性骨质疏松性骨折研究（MrOS）美国研究，他们的指数测量值在指数骨折前 5 年内进行了评估。还使用线性混合效应回归来检查指数骨折后肌肉力量和表现的年度下降与死亡率的关系。使用 Cox 比例风险模型调整年龄、股骨颈骨密度（FN BMD）、先前骨折、跌倒、体重指数（BMI）、指数骨折部位、生活方式因素和合并症，评估了这些关联。从指数骨折到随后骨折的中位随访时间为 3.7 年（四分位距 [IQR]，1.3-8.1 年），201 名（24%）男性发生了随后骨折，5.1 年（IQR，1.8-9.6 年）至死亡，536 名（65%）男性死亡。指数测量值与随后的骨折无关（危险比 [HR] 范围为 0.97 至 1.07）。然而，它们与骨折后死亡率有关。握力每下降 1 个标准差（1-SD）的 HR（95%CI，1.01-1.25）和步态速度：HR 1.14（95%CI，1.02-1.27），以及坐站时间每增加 1-SD：HR 1.08（95%CI，0.97-1.21）。这些测量值的年下降幅度越大，与死亡率风险越高相关，独立于指数值和其他协变量。握力每年下降 1-SD 的 HR（95%CI，1.01-1.33）和步态速度：HR 1.38（95%CI，1.13-1.68），以及每年增加 1-SD 的坐站时间：HR 1.28（95%CI，1.07-1.54）。与完成所有测试的男性相比，无法完成一项或多项测试的男性骨折后死亡率风险更高（24%-109%）。这些可改变因素的改善是否能降低骨折后死亡率还有待观察。
