严重骨质疏松性骨折病史与后续髋部骨折之间的关联：一项系统评价和荟萃分析。
Association between a history of major osteoporotic fractures and subsequent hip fracture: a systematic review and meta-analysis.
作者信息
Ariie Takashi, Yamamoto Norio, Tsutsumi Yusuke, Nakao Shuri, Saitsu Akihiro, Tsuge Takahiro, Tsuda Haruka, Nakashima Yuki, Miura Takanori, Bandai Yousuke, Okoba Ryota, Taito Shunsuke
机构信息
Department of Physical Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, 137-1 Enokizu, Okawa-Shi, Fukuoka, 831-8501, Japan.
Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
出版信息
Arch Osteoporos. 2024 May 31;19(1):44. doi: 10.1007/s11657-024-01393-4.
PURPOSE
A history of fractures involving the distal radius, proximal humerus, spine, and hip may be associated with the incidence of subsequent hip fractures in older people. However, a comprehensive summary of this association using a rigorous methodology is lacking. Our objective was to systematically review the literature and examine the association between four major osteoporotic fractures and subsequent hip fractures in individuals aged ≥ 50 years.
METHODS
We searched MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov on February 15, 2023. The search included cohort or case-control studies investigating the association between these four types of osteoporotic fractures and subsequent hip fractures. We pooled the hazard ratios (HRs) with 95% confidence intervals (CI) using the random-effects model. We used the Quality In Prognosis Studies tool to assess the risk of bias in the included studies, and the grading of recommendations assessment, development, and evaluation approach to determine the certainty of evidence.
RESULTS
The selection process identified 48 studies for qualitative synthesis and 23 studies (2,239,217 participants) for meta-analysis. The overall methodological quality had a low risk of bias in 65% of the included studies. The association between a history of major osteoporotic fractures and subsequent hip fracture varied, with a high certainty of evidence for a history of proximal humerus and hip fractures (HR 2.02, 95% CI 1.75-2.33 and 2.86, 95% CI 1.92-4.25, respectively), moderate certainty for distal radius fractures (HR 1.66, 95% CI 1.53-1.81), and low certainty for spine fractures (HR 1.53, 95% CI 1.38-1.69).
CONCLUSIONS
In conclusion, a history of major osteoporotic fractures, particularly distal radius, proximal humerus, and hip fractures, is associated with subsequent hip fractures in older adults. Further research is needed to verify the association between a history of spine fracture and subsequent hip fractures.
PROTOCOL REGISTRATION
Open Science Framework ( https://osf.io/7fjuc ).
目的
桡骨远端、肱骨近端、脊柱和髋部骨折史可能与老年人随后发生髋部骨折的发生率相关。然而，缺乏使用严谨方法对此关联进行的全面总结。我们的目的是系统回顾文献，并研究≥50岁个体中四种主要骨质疏松性骨折与随后髋部骨折之间的关联。
方法
我们于2023年2月15日检索了MEDLINE、Embase、CENTRAL、ICTRP和ClinicalTrials.gov。检索包括队列研究或病例对照研究，调查这四种骨质疏松性骨折与随后髋部骨折之间的关联。我们使用随机效应模型汇总风险比（HRs）及其95%置信区间（CI）。我们使用预后研究质量工具评估纳入研究中的偏倚风险，并使用推荐分级评估、制定和评价方法来确定证据的确定性。
结果
筛选过程确定了48项研究进行定性综合分析，23项研究（2239217名参与者）进行荟萃分析。纳入研究中65%的总体方法学质量具有低偏倚风险。主要骨质疏松性骨折史与随后髋部骨折之间的关联各不相同，肱骨近端和髋部骨折史的证据确定性高（HR分别为2.02，95%CI 1.75 - 2.33和2.86，95%CI 1.92 - 4.25），桡骨远端骨折的证据确定性中等（HR 1.66，95%CI 1.53 - 1.81），脊柱骨折的证据确定性低（HR 1.53，95%CI 1.38 - 1.69）。
结论
总之，主要骨质疏松性骨折史，尤其是桡骨远端、肱骨近端和髋部骨折史，与老年人随后发生髋部骨折相关。需要进一步研究以验证脊柱骨折史与随后髋部骨折之间的关联。
方案注册
开放科学框架（https://osf.io/7fjuc）
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