Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
Osteoporos Int. 2023 Dec;34(12):2027-2045. doi: 10.1007/s00198-023-06870-z. Epub 2023 Aug 11.
UNLABELLED: A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION: The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS: We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. RESULTS: A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION: A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
未加标签：一项使用来自 64 个队列的主要数据的大型国际荟萃分析，对既往骨折史与未来 FRAX 骨折风险之间的关系进行了量化。
引言：本研究的目的是量化国际范围内既往骨折与骨折风险之间的关系，并探讨该风险与年龄、性别、基线后时间和骨密度（BMD）之间的关系。
方法：我们研究了来自 32 个国家的 64 个队列中的 665971 名男性和 1438535 名女性，随访总人数为 1950 万人年。在每个队列中，使用扩展泊松模型检查既往骨折史对任何临床骨折、任何骨质疏松性骨折、主要骨质疏松性骨折和髋部骨折的风险的影响。检查的协变量包括年龄、性别、BMD 和随访时间。通过使用加权β系数对不同研究的结果进行合并。
结果：与无既往骨折史的个体相比，既往骨折史与任何临床骨折（危险比，HR = 1.88；95%置信区间，CI = 1.72-2.07）的风险显著增加。骨质疏松性骨折（HR = 1.87；95%CI = 1.69-2.07）、主要骨质疏松性骨折（HR = 1.83；95%CI = 1.63-2.06）或髋部骨折（HR = 1.82；95%CI = 1.62-2.06）的风险比也相似。男性和女性之间的风险比无显著差异。当考虑到 BMD 时，随后的骨折风险略有向下调整。BMD 仅能解释任何临床骨折（14%）、骨质疏松性骨折（17%）和髋部骨折（33%）风险的一小部分。在调整年龄和基线后检查时间后，所有骨折结局与既往骨折相关的风险比显著降低。
结论：既往骨折史导致的骨折风险显著增加，这超出了 BMD 所能解释的程度。该影响在男性和女性中相似。在国际范围内对其进行量化，可使该风险因素在病例发现策略中的应用更加准确。
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