Fujiwara Saeko, Buchanan-Hughes Amy, Ng Alvin, Page Jennifer, Adachi Kenji, Li Hong
Yasuda Women's University, Hiroshima, Japan.
Costello Medical, Boston, MA, USA.
Osteoporos Int. 2022 Oct;33(10):2205-2216. doi: 10.1007/s00198-022-06472-1. Epub 2022 Jul 2.
In Japanese patients who experienced an osteoporotic fracture, 10.8% and 18.6% had a subsequent fracture within 1 and 2 years of follow-up, respectively. Although the burden of hip and vertebral fractures has been reported widely, we found that patients with non-hip non-vertebral (NHNV) fractures had a 26% higher risk of subsequent fracture than patients with hip fractures; therefore, NHNV fractures should also be considered an important risk factor for subsequent fracture.
To investigate imminent risk and odds of subsequent osteoporotic fractures and associated risk factors in patients who experienced an initial osteoporotic fracture.
Patients aged ≥ 50 years with ≥ 1 osteoporotic fracture were analyzed from Japan's Medical Data Vision (MDV) database of claims from acute-care hospitals (January 2012-January 2017). Multivariable models were constructed to explore the impact of key comorbidities and medications on the subsequent fracture risk: Cox proportional hazards model for time to subsequent fracture and logistic regression models for odds of subsequent fracture within 1 and 2 years from index fracture.
In total, 32,926 patients were eligible with a median follow-up duration of 12.3 months. The percentage of patients experiencing subsequent fractures was 14.1% across the study duration, and 10.8% and 18.6% in patients with 1 and 2 years of follow-up, respectively. In the Cox proportional hazards model, patients with vertebral or NHNV index fractures had a higher subsequent fracture risk than patients with a hip index fracture (adjusted hazard ratio [aHR] 1.11 and 1.26, respectively); subsequent fracture risk was lower in males than females (aHR 0.89). Patients with baseline claims for tranquilizers and glucocorticoids had a higher subsequent fracture risk than those without (aHR 1.14 and 1.08, respectively). Additionally, baseline claims for anti-Parkinson's medications, alcoholism, and stage 4/5 chronic kidney disease were significantly associated with higher odds of subsequent fracture in the logistic regression models.
Several clinical and demographic factors were associated with a higher risk and odds of subsequent fracture. This may help to identify patients who should be prioritized for osteoporosis treatment.
在经历骨质疏松性骨折的日本患者中，分别有10.8%和18.6%的患者在随访1年和2年内再次发生骨折。尽管髋部和椎体骨折的负担已被广泛报道，但我们发现，非髋非椎体（NHNV）骨折患者发生后续骨折的风险比髋部骨折患者高26%；因此，NHNV骨折也应被视为后续骨折的一个重要危险因素。
调查初次发生骨质疏松性骨折的患者发生后续骨质疏松性骨折的近期风险、几率及相关危险因素。
从日本急性护理医院的医疗数据视觉（MDV）索赔数据库（2012年1月至2017年1月）中分析年龄≥50岁且有≥1次骨质疏松性骨折的患者。构建多变量模型以探讨关键合并症和药物对后续骨折风险的影响：用于后续骨折时间的Cox比例风险模型以及用于指数骨折后1年和2年内后续骨折几率的逻辑回归模型。
共有32926名患者符合条件，中位随访时间为12.3个月。在整个研究期间，发生后续骨折的患者比例为14.1%，随访1年和2年的患者中这一比例分别为10.8%和18.6%。在Cox比例风险模型中，椎体或NHNV指数骨折的患者比髋部指数骨折的患者有更高的后续骨折风险（调整后风险比[aHR]分别为1.11和1.26）；男性的后续骨折风险低于女性（aHR 0.89）。有镇静剂和糖皮质激素基线索赔记录的患者比没有这些记录的患者有更高的后续骨折风险（aHR分别为1.14和1.08）。此外，在逻辑回归模型中，抗帕金森药物、酗酒和4/5期慢性肾病的基线索赔记录与后续骨折几率较高显著相关。
一些临床和人口统计学因素与后续骨折的较高风险和几率相关。这可能有助于识别应优先接受骨质疏松症治疗的患者。
