预测“首次骨折时间”的风险因素及其与即将发生的骨折的关系：FRISBEE 队列的子研究。
Risk factors predicting the 'time to first fracture' and its association with imminent fractures: a substudy of the FRISBEE cohort.
机构信息
Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Place A. Van Gehuchten 4, 1020 Laken, Brussels, Belgium.
Laboratoire de Recherche Translationnelle, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
出版信息
Arch Osteoporos. 2023 Jun 28;18(1):88. doi: 10.1007/s11657-023-01296-w.
UNLABELLED
Only previous glucocorticoid use and rheumatoid arthritis were predictors of an early fracture (< 2 years after inclusion). A shorter 'time to first fracture' was not an independent clinical risk factor for imminent fractures.
PURPOSE
Risk factors for fragility fractures independent of BMD were assessed in several prediction models. However, predictors of a shorter 'time to first fracture' and its impact on imminent fractures are unknown.
METHODS
We studied the concept of 'time to first fracture' in the FRISBEE ("Fracture RIsk Brussels Epidemiological Enquiry") cohort (3560 postmenopausal women). Validated fractures were divided into 3 groups: first fracture < 2 years, 2-5 years, and > 5 years after inclusion. Factors associated with first fracture risk were evaluated with uni- and multivariate analyses using Cox modeling. We examined 'time to first fracture' as a risk factor for imminent fractures in untreated subjects and in those receiving pharmacological treatment.
RESULTS
Classical risk factors (age, prior fracture, fall history and low BMD) were associated with first fracture in all groups. Previous glucocorticoids and rheumatoid arthritis (RA) were predictors for fracture < 2 years. Imminent fractures were similar in subjects with or without osteoporosis treatment, despite a higher estimated 10-year risk of fragility fracture in those treated, suggesting that treatment is efficient. 'Time to first fracture' was not an independent risk factor for imminent fractures.
CONCLUSION
Among the risk factors considered, previous glucocorticoid use and RA were predictors for early fracture, consistent with the concept of very high risk. The 'time to first validated fracture' was not an independent risk factor for imminent fractures. Patients with a first osteoporotic fracture should thus be considered at very high risk for re-fracture, independent of the 'time to first fracture'.
不明确
仅既往糖皮质激素使用和类风湿关节炎是早期骨折（<2 年后纳入）的预测因素。较短的“首次骨折时间”并不是即将发生骨折的独立临床危险因素。
目的
评估了几个预测模型中与 BMD 无关的脆性骨折危险因素。然而，较短的“首次骨折时间”的预测因素及其对即将发生的骨折的影响尚不清楚。
方法
我们研究了 FRISBEE（“骨折风险布鲁塞尔流行病学研究”）队列（3560 名绝经后妇女）中“首次骨折时间”的概念。将确诊骨折分为 3 组：纳入后<2 年、2-5 年和>5 年发生的首次骨折。使用 Cox 建模进行单变量和多变量分析评估与首次骨折风险相关的因素。我们检查了未经治疗的受试者和接受药物治疗的受试者中“首次骨折时间”作为即将发生骨折的危险因素。
结果
经典危险因素（年龄、既往骨折、跌倒史和低 BMD）在所有组中与首次骨折相关。既往糖皮质激素和类风湿关节炎（RA）是<2 年内骨折的预测因素。尽管接受治疗者的脆性骨折 10 年估计风险较高，但在接受骨质疏松治疗或未接受骨质疏松治疗的患者中，即将发生的骨折相似，这表明治疗有效。“首次骨折时间”不是即将发生骨折的独立危险因素。
结论
在所考虑的危险因素中，既往糖皮质激素使用和 RA 是早期骨折的预测因素，这与极高风险的概念一致。“首次确诊骨折时间”不是即将发生骨折的独立危险因素。因此，首次发生骨质疏松性骨折的患者应被视为再次骨折的极高风险，与“首次骨折时间”无关。
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