Department of Orthopedics, Affiliated Kunshan Hospital of Jiangsu University, No. 566 East of Qianjin Road, Suzhou, 215300, Jiangsu, China.
Department of Orthopedics, The First People's Hospital of KunshanGusu School, Nanjing Medical University, Suzhou, 215300, Jiangsu, China.
Osteoporos Int. 2024 Oct;35(10):1737-1748. doi: 10.1007/s00198-024-07142-0. Epub 2024 Jun 6.
We conducted a retrospective cohort analysis to examine the association between hemoglobin (Hb) levels and refracture risk in elderly patients with osteoporotic fractures (OPFs). Our findings suggest a nonlinear relationship exists in females, and females with Hb levels below 10.7 g/dL may be at a higher risk of refracture.
Hematopoiesis and bone health have a reciprocal influence on each other. Nevertheless, there is a scarcity of in-depth research on the association between Hb levels and the occurrence of fractures. The present research aimed to investigate the correlation between Hb levels and the rate of refracture within 5 years among individuals with OPFs.
A retrospective cohort analysis was undertaken between 2017 and 2022. The study included 1906 individuals who were inhabitants of Kunshan and were over 60 years old. These individuals had experienced an OPF between January 1, 2017, and July 27, 2022, resulting in their hospitalization. Cox proportional hazard regression models were used to evaluate the risk of refracture within 5 years based on the Hb levels acquired during the admission examination, with consideration for sex differences. A nonlinear relationship was identified using smoothed curve fitting and threshold analysis. Kaplan-Meier curves were used to compare refracture rates between patients with low and high Hb levels.
Elderly female patients with OPFs and lower Hb levels exhibited a significantly higher risk of a 5-year refracture. Conversely, no significant associations were observed between the two variables in male patients. A nonlinear correlation was found between Hb levels and the probability of refracture in females, with a turning point identified at 10.7 g/dL of Hb levels. A strong negative association was observed with the five-year refracture rate when Hb levels fell below 10.7 g/dL (hazard ratio (HR) = 0.63; 95% confidence interval (CI) 0.48 to 0.83; P-value = 0.0008). This finding suggests that for every 1 g/dL increase in Hb below 10.7 g/dL, the risk of refracture reduced by 37%. However, no statistically significant association was observed when Hb levels were above 10.7 g/dL.
The findings demonstrated a significant negative correlation between Hb levels and the likelihood of refracture in elderly female patients with OPFs and suggested that elderly females with recent OPFs and Hb levels below 10.7 g/dL may be at a higher risk of refracture. Additionally, the Hb levels can serve as an indicator of bone fragility in elderly female patients with OPFs. These findings highlight the importance of monitoring Hb levels as a part of comprehensive management strategies to both assess skeletal health and prevent refractures in this population.
我们进行了一项回顾性队列分析，以研究血红蛋白（Hb）水平与老年骨质疏松性骨折（OPF）患者再骨折风险之间的关系。我们的研究结果表明，女性存在非线性关系，Hb 水平低于 10.7g/dL 的女性再骨折风险可能更高。
造血和骨骼健康相互影响。然而，Hb 水平与骨折发生之间的关联尚未得到深入研究。本研究旨在探讨 OPF 患者 Hb 水平与 5 年内再骨折率之间的相关性。
我们于 2017 年至 2022 年期间进行了一项回顾性队列分析。该研究纳入了 1906 名年龄在 60 岁以上、居住在昆山的居民，这些居民在 2017 年 1 月 1 日至 2022 年 7 月 27 日期间因 OPF 住院。采用 Cox 比例风险回归模型，根据入院检查时获得的 Hb 水平，考虑性别差异，评估 5 年内再骨折的风险。采用平滑曲线拟合和阈值分析确定非线性关系。Kaplan-Meier 曲线用于比较 Hb 水平较低和较高的患者之间的再骨折率。
患有 OPF 的老年女性患者，Hb 水平较低，5 年内再骨折的风险显著增加。相反，男性患者中两个变量之间无显著相关性。女性 Hb 水平与再骨折概率之间存在非线性关系，Hb 水平为 10.7g/dL 时为转折点。当 Hb 水平低于 10.7g/dL 时，5 年内再骨折率与 Hb 水平呈强负相关（风险比（HR）=0.63；95%置信区间（CI）0.48 至 0.83；P 值=0.0008）。这表明，Hb 每降低 1g/dL，再骨折的风险就降低 37%。然而，当 Hb 水平高于 10.7g/dL 时，没有观察到统计学意义上的相关性。
研究结果表明，OPF 老年女性患者 Hb 水平与再骨折风险之间存在显著负相关，提示近期发生 OPF 且 Hb 水平低于 10.7g/dL 的老年女性再骨折风险较高。此外，Hb 水平可作为评估老年 OPF 女性患者骨脆性的指标。这些发现强调了监测 Hb 水平的重要性，作为评估骨骼健康和预防该人群再骨折的综合管理策略的一部分。
