Campus for Research Excellence and Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore.
Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Osteoporos Int. 2024 Jul;35(7):1231-1241. doi: 10.1007/s00198-024-07096-3. Epub 2024 Apr 24.
There is imminent refracture risk in elderly individuals for up to six years, with a decline thereafter except in women below 75 who face a constant elevated risk. Elderly men with fractures face the highest mortality risk, particularly those with hip and vertebral fractures. Targeted monitoring and treatment strategies are recommended.
Current management and interventions for osteoporotic fractures typically focus on bone mineral density loss, resulting in suboptimal evaluation of fracture risk. The aim of the study is to understand the progression of fractures to refractures and mortality in the elderly using multi-state models to better target those at risk.
This prospective, observational study analysed data from the AGES-Reykjavik cohort of Icelandic elderly, using multi-state models to analyse the evolution of fractures into refractures and mortality, and to estimate the probability of future events in subjects based on prognostic factors.
At baseline, 4778 older individuals aged 65 years and older were included. Elderly men, and elderly women above 80 years of age, had a distinct imminent refracture risk that lasted between 2-6 years, followed by a sharp decline. However, elderly women below 75 continued to maintain a nearly constant refracture risk profile for ten years. Hip (30-63%) and vertebral (24-55%) fractures carried the highest 5-year mortality burden for elderly men and women, regardless of age, and for elderly men over 80, lower leg fractures also posed a significant mortality risk.
The risk of refracture significantly increases in the first six years following the initial fracture. Elderly women, who experience fractures at a younger age, should be closely monitored to address their long-term elevated refracture risk. Elderly men, especially those with hip and vertebral fractures, face substantial mortality risk and require prioritized monitoring and treatment.
目前骨质疏松性骨折的管理和干预措施通常侧重于骨密度的丧失，导致对骨折风险的评估不够理想。本研究旨在通过多状态模型来了解老年人骨折向再骨折和死亡的进展，以便更好地针对高危人群。
这是一项前瞻性、观察性研究，分析了来自冰岛老年人群的 AGES-Reykjavik 队列的数据，使用多状态模型来分析骨折向再骨折和死亡的演变，并根据预后因素估计受试者未来事件的概率。
在最初骨折后的前 6 年，再骨折的风险显著增加。老年女性在更年轻时发生骨折，应密切监测以解决其长期升高的再骨折风险。老年男性，尤其是髋部和椎体骨折的男性，面临着较大的死亡风险，需要优先监测和治疗。
