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髋部骨折与绝经后女性雌激素的使用。弗明汉姆研究。

Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study.

作者信息

Kiel D P, Felson D T, Anderson J J, Wilson P W, Moskowitz M A

机构信息

Multipurpose Arthritis Center, Boston University Medical Center, Mass.

出版信息

N Engl J Med. 1987 Nov 5;317(19):1169-74. doi: 10.1056/NEJM198711053171901.

Abstract

To assess the effect of postmenopausal use of estrogens on the subsequent risk of hip fracture, we performed a retrospective cohort study of 2873 women in the Framingham Heart Study. Information obtained at routine biennial examinations about the use of estrogens, body weight, age at menopause, smoking, and alcohol consumption was used to evaluate the risk of hip fracture among postmenopausal women who received estrogens. Hip fractures occurred in 179 postmenopausal women, at a rate that increased exponentially after the age of 50. The risk of fracture was inversely related to weight at all ages. The relative risk of hip fracture in subjects who had taken estrogens at any time was 0.65 after adjustment for age and weight (95 percent confidence interval, 0.44 to 0.98). The adjusted relative risk in women who had taken estrogens within the previous two years was further reduced, to 0.34 (95 percent confidence interval, 0.12 to 0.98). Taking estrogens within four years of menopause also protected against fracture. The number of women in each age group who took estrogens was insufficient for a definitive evaluation of risk, but recent use of estrogens appeared to be protective in women under the age of 65 (no fractures among those who took estrogens) and those 65 to 74. We cannot exclude some degree of selection bias among the women who received estrogen-replacement therapy. Nevertheless, this large cohort study supports the hypothesis that postmenopausal use of estrogens protects against subsequent hip fracture in women.

摘要

为评估绝经后使用雌激素对随后髋部骨折风险的影响,我们在弗雷明汉心脏研究中对2873名女性进行了一项回顾性队列研究。在每两年一次的常规检查中获取的关于雌激素使用、体重、绝经年龄、吸烟和饮酒情况的信息,用于评估接受雌激素治疗的绝经后女性发生髋部骨折的风险。179名绝经后女性发生了髋部骨折,骨折发生率在50岁以后呈指数增长。在所有年龄段,骨折风险均与体重呈负相关。在对年龄和体重进行调整后,曾在任何时间服用过雌激素的受试者发生髋部骨折的相对风险为0.65(95%置信区间为0.44至0.98)。在过去两年内服用过雌激素的女性,调整后的相对风险进一步降低至0.34(95%置信区间为0.12至0.98)。在绝经后四年内服用雌激素也可预防骨折。每个年龄组中服用雌激素的女性人数不足以进行明确的风险评估,但近期使用雌激素似乎对65岁以下女性(服用雌激素者无骨折发生)和65至74岁女性具有保护作用。我们不能排除接受雌激素替代疗法的女性中存在一定程度的选择偏倚。尽管如此,这项大型队列研究支持以下假设:绝经后使用雌激素可预防女性随后发生髋部骨折。

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