基于衰弱和骨密度预测农村社区居住的老年人脆性骨折。

Predicting fragility fractures based on frailty and bone mineral density among rural community-dwelling older adults.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea.

出版信息

Eur J Endocrinol. 2024 Jul 2;191(1):75-86. doi: 10.1093/ejendo/lvae080.

DOI:10.1093/ejendo/lvae080

PMID:38970525

Abstract

OBJECTIVE

We aim to investigate the association between bone mineral density (BMD) measurement and fragility fractures and assess the predictive value of combining BMD measurement and frailty for fracture risk assessment.

METHODS

This retrospective cohort study analyzed data from 5126 rural Koreans in the Chungju Metabolic Disease Cohort study. Frailty was defined using Fried's frailty phenotype. Fractures were assessed via structured medical interviews. Adjusted odds ratios (ORs) were calculated considering age, sex, body mass index, behavior, BMD, handgrip strength, medications, and comorbidities.

RESULTS

The study cohort consisted of 5126 participants comprising 1955 (38.1%) males and 3171 (61.9%) females. Osteoporosis significantly increased the fracture risk across all types, except vertebral fracture, with adjusted OR (95% CI) of 1.89 (1.23-3.47) for any fracture, 2.05 (1.37-2.98) for hip fracture, 2.18 (1.06-4.50) for other fracture, and 1.71 (1.03-3.63) for major osteoporotic fracture (MOF). Frail individuals exhibited significantly increased risk for any fracture (OR 2.12; 95% CI, 1.21-3.71), vertebral fracture (2.48; 1.84-3.61), hip fracture (2.52; 1.09-3.21), other fracture (2.82; 1.19-8.53), and MOF (1.87; 1.01-3.47). The combination of frailty and BMD further increased the risks, with frail individuals demonstrating elevated ORs across BMD categories. In subgroup analyses, men showed a significant association between frailty with osteoporosis in hip fracture and MOF. Frail women with osteoporosis exhibited the highest risks for all fractures, particularly vertebral (OR 5.12; 95% CI, 2.07-9.68) and MOF (OR 5.19; 95% CI, 2.07-6.61). Age-specific analysis revealed that individuals aged 70 and older exhibited markedly higher fracture risks compared with those under 70. The combination of frailty and low BMD further elevated the fracture risk. Frailty was applied with BMD and demonstrated superior risk prediction for MOF compared with that with either score alone (area under the curve 0.825; P = .000).

CONCLUSIONS

Combining frailty with BMD provides a more accurate fracture risk assessment for individuals over 50 years.

摘要

目的

本研究旨在探讨骨密度（BMD）测量与脆性骨折之间的关联，并评估将 BMD 测量与虚弱相结合用于骨折风险评估的预测价值。

方法

本回顾性队列研究分析了忠州代谢性疾病队列研究中 5126 名农村韩国人的数据。使用 Fried 的虚弱表型定义虚弱。通过结构化医疗访谈评估骨折情况。考虑年龄、性别、体重指数、行为、BMD、握力、药物和合并症，计算调整后的优势比（OR）。

结果

研究队列包括 5126 名参与者，其中 1955 名（38.1%）为男性，3171 名（61.9%）为女性。骨质疏松症使所有类型的骨折风险显著增加，除了椎体骨折，调整后的 OR（95%CI）分别为 1.89（1.23-3.47）的任何骨折、2.05（1.37-2.98）的髋部骨折、2.18（1.06-4.50）的其他骨折和 1.71（1.03-3.63）的主要骨质疏松性骨折（MOF）。虚弱个体的任何骨折（OR 2.12；95%CI，1.21-3.71）、椎体骨折（2.48；1.84-3.61）、髋部骨折（2.52；1.09-3.21）、其他骨折（2.82；1.19-8.53）和 MOF（1.87；1.01-3.47）的风险显著增加。虚弱和 BMD 的结合进一步增加了风险，虚弱个体在所有 BMD 类别中表现出更高的 OR。在亚组分析中，男性在髋部骨折和 MOF 中表现出虚弱与骨质疏松症之间的显著关联。患有骨质疏松症的虚弱女性所有骨折的风险最高，尤其是椎体骨折（OR 5.12；95%CI，2.07-9.68）和 MOF（OR 5.19；95%CI，2.07-6.61）。年龄特异性分析显示，70 岁及以上的个体与 70 岁以下的个体相比，骨折风险明显更高。虚弱和低 BMD 的结合进一步增加了骨折风险。虚弱与 BMD 相结合，对 MOF 的风险预测优于单独使用任何一种评分（曲线下面积 0.825；P=.000）。