Juels Michaela, Larson Joseph C, Ensrud Kristine E, Stefanick Marcia L, Shadyab Aladdin H, Garcia Lorena, Nassir Rami, Schnatz Peter F, Nelson Rebecca, Crandall Carolyn J
David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
J Gen Intern Med. 2025 Apr 24. doi: 10.1007/s11606-025-09506-6.
Major osteoporotic fracture (MOF) is associated with increased mortality; however, few studies in postmenopausal women have examined racial and ethnic differences in 1-year and 5-year mortality following MOF.
To assess 1-year and 5-year mortality following MOF by race and ethnicity.
This prospective cohort study included postmenopausal women enrolled in the Women's Health Initiative (WHI), a population-based, multisite US study. Participants were followed from September 1994 to February 2023. Data were analyzed between August 2023 and November 2023.
Postmenopausal women aged 50 to 79 years old who experienced a MOF (N = 32,675 in 1 year and 29,506 in 5 years following MOF).
Self-reported race and ethnicity. All-cause mortality was determined by death certificates, reports of surrogates, and the National Death Index Search.
The baseline mean age of participants was 77.0 [SD = 8.5] years with 31,223 [95.6%] White participants in the 1-year mortality analysis, and 76.3 [SD = 8.5] years with 28,212 [95.6%] White participants in the 5-year mortality analysis. In fully adjusted models, compared to White women, Black women had a higher risk of mortality (adjusted odds ratio (aOR) = 1.42, 95% CI [1.06, 1.90], while Asian women had a lower risk of mortality (aOR = 0.48 95% CI [0.27, 0.88]), within 1 year following MOF. Compared to White women, the mortality risk within 5 years after MOF was significantly higher among American Indian/Alaska Native (aOR = 3.30, 95% CI [1.65, 6.60]) and lower among Asian (aOR = 0.58, 95% CI [0.42,0.80]) women. While there were no mortality differences by ethnicity 1 year following MOF, Hispanic/Latina women were less likely to die 5 years following MOF (aOR = 0.74, [95% CI 0.57-0.96]) compared to Non-Hispanic/Latina women.
In this large prospective study, mortality following MOF differed by race. Future research is needed to delineate the mechanism behind these associations.
严重骨质疏松性骨折（MOF）与死亡率增加相关；然而，很少有针对绝经后女性的研究探讨MOF后1年和5年死亡率的种族和民族差异。
按种族和民族评估MOF后的1年和5年死亡率。
这项前瞻性队列研究纳入了参与美国一项基于人群的多中心研究——女性健康倡议（WHI）的绝经后女性。参与者从1994年9月开始随访至2023年2月。数据于2023年8月至2023年11月进行分析。
年龄在50至79岁之间经历过MOF的绝经后女性（MOF后1年有32,675人，5年有29,506人）。
自我报告的种族和民族。全因死亡率通过死亡证明、代理人报告以及国家死亡指数搜索来确定。
在1年死亡率分析中，参与者的基线平均年龄为77.0[标准差=8.5]岁，其中白人参与者有31,223人[95.6%]；在5年死亡率分析中，基线平均年龄为76.3[标准差=8.5]岁，白人参与者有28,212人[95.6%]。在完全调整模型中，与白人女性相比，黑人女性在MOF后1年内死亡风险更高（调整后的优势比（aOR）=1.42，95%置信区间[1.06,1.90]），而亚洲女性死亡风险较低（aOR=0.48，95%置信区间[0.27,0.88]）。与白人女性相比，美国印第安人/阿拉斯加原住民在MOF后5年内的死亡风险显著更高（aOR=3.30，95%置信区间[1.65,6.60]），而亚洲女性较低（aOR=0.58，95%置信区间[0.42,0.80]）。虽然MOF后1年按民族划分的死亡率没有差异，但与非西班牙裔/拉丁裔女性相比，西班牙裔/拉丁裔女性在MOF后5年死亡的可能性较小（aOR=0.74，[95%置信区间0.57 - 0.96]）。
在这项大型前瞻性研究中，MOF后的死亡率因种族而异。需要进一步研究来阐明这些关联背后的机制。
