Skjødt Michael Kriegbaum, Nicolaes Joeri, Smith Christopher Dyer, Olsen Kim Rose, Cooper Cyrus, Libanati Cesar, Abrahamsen Bo
Department of Medicine Holbæk Hospital Holbæk Denmark.
OPEN-Open Patient data Explorative Network, Department of Clinical Research University of Southern Denmark and Odense University Hospital Odense Denmark.
JBMR Plus. 2023 Mar 15;7(5):e10736. doi: 10.1002/jbm4.10736. eCollection 2023 May.
Vertebral fractures (VFs) have been associated with future fractures, yet few studies have evaluated whether this pertains to VFs available for identification on routine radiological imaging. We sought to evaluate the risk of subsequent fractures in subjects with VF identified opportunistically on computed tomography (CT) scans performed as part of routine clinical practice. From the radiology database of Holbæk Hospital we identified the first CT scan including the thorax and/or abdomen of 2000 consecutive men and women aged 50 years or older, performed from January 1, 2010 onward. The scans were assessed in a blinded approach to identify chest and lumbar VF, and these data linked to national Danish registers. Subjects were excluded if treated with an osteoporosis medication (OM) in the year prior to baseline (date of CT), and the remaining subjects with VF matched on age and sex in 1:2 ratio against subjects with no VF. We found that the risk of major osteoporotic fractures (hip, non-cervical vertebral, humerus, and distal forearm fractures) was higher for subjects with VF than without VF: incidence rates (IRs) were 32.88 and 19.59 fractures per 1000 subject-years, respectively, and the adjusted hazard ratio (HR) was 1.72 (95% confidence interval [CI], 1.03-2.86). Subsequent hip fracture IRs were 16.75 and 6.60; HR 3.02 (95% CI, 1.39-6.55). There were no significant differences in other fracture outcomes (including a pooled estimate of any subsequent fracture, except face, skull, and fingers: IRs 41.52 and 31.38; HR 1.31 [95% CI, 0.85-2.03]). Our findings suggest that subjects undergoing routine CT scans including the chest and/or abdomen are a high risk population in terms of fracture risk. Even within this group, subjects with VF are at higher risk of future major osteoporotic fracture (MOF), in particular hip fracture. Hence, systematic opportunistic screening for VF and subsequent fracture risk management is important to reduce the risk of new fractures. © 2023 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
椎体骨折（VFs）与未来骨折相关，但很少有研究评估这是否适用于常规放射影像学上可识别的椎体骨折。我们试图评估在作为常规临床实践一部分进行的计算机断层扫描（CT）中偶然发现椎体骨折的受试者发生后续骨折的风险。从霍尔拜克医院的放射学数据库中，我们识别出2010年1月1日起对2000名年龄在50岁及以上的连续男性和女性进行的首次包括胸部和/或腹部的CT扫描。以盲法评估扫描结果以识别胸部和腰椎椎体骨折，并将这些数据与丹麦国家登记处关联。如果在基线（CT日期）前一年接受过骨质疏松症药物（OM）治疗，则将受试者排除，其余椎体骨折受试者按年龄和性别以1:2的比例与无椎体骨折的受试者匹配。我们发现，有椎体骨折的受试者发生主要骨质疏松性骨折（髋部、非颈椎椎体、肱骨和远端前臂骨折）的风险高于无椎体骨折的受试者：发病率分别为每1000人年32.88例和19.59例骨折，调整后的风险比（HR）为1.72（95%置信区间[CI]，1.03 - 2.86）。后续髋部骨折发病率分别为16.75例和6.60例；HR为3.02（95%CI，1.39 - 6.55）。其他骨折结局无显著差异（包括除面部、颅骨和手指外任何后续骨折的合并估计：发病率分别为41.52例和31.38例；HR为1.31[95%CI，0.85 - 2.03]）。我们的研究结果表明，接受包括胸部和/或腹部的常规CT扫描的受试者在骨折风险方面是高危人群。即使在这个群体中，有椎体骨折的受试者未来发生主要骨质疏松性骨折（MOF）的风险更高，尤其是髋部骨折。因此，系统地对椎体骨折进行机会性筛查并进行后续骨折风险管理对于降低新骨折风险很重要。©2023作者。由Wiley Periodicals LLC代表美国骨与矿物质研究学会出版。
