Shin Junghwa, Kim Kwang Yoon, Park Joo-Hyun, Lee Sangmi, Noh O Kyu, Choi Yong Jun, Chung Yoon-Sok, Kim Bom-Taeck
Department of Family Medicine, Korea University College of Medicine, Ansan, South Korea.
Department of Family Practice and Community Health, Ajou University School of Medicine, Suwon, South Korea.
Osteoporos Sarcopenia. 2025 Jun;11(2):65-68. doi: 10.1016/j.afos.2025.03.001. Epub 2025 Apr 8.
Fracture risk in postmenopausal women is influenced by bone mineral density (BMD), age, and body mass index (BMI). However, fracture prevention strategies primarily focus on low BMD, often overlooking other key factors.
This retrospective cohort study analyzed 18,151 Korean postmenopausal women aged 50 or older who underwent dual-energy X-ray absorptiometry (DXA) at Ajou University Hospital from years of 2006-2014. Fracture risk was assessed using multivariable Cox proportional hazard models, adjusted for BMI, BMD, and age.
The median age of the cohort was 59.1 years, and the overall fracture incidence was 2.3 per 1,000 person-years. Fracture risk significantly increased with age, with hazard ratios (HRs) of 1.36 (95% CI: 1.08-1.70) for women aged 60-69 and 2.10% (95% CI: 1.62-2.73) for those aged 70 or older, compared to the reference group (50-59 years). Underweight women exhibited the highest fracture cumulative incidence (3.3%), though their risk increase was not statistically significant. Overweight and obese women demonstrated higher BMD but did not show significant fracture risk reductions.
These findings highlight age as a dominant predictor of fracture risk, while BMI plays a complex, less pronounced role. The discrepancy between osteoporosis prevalence and actual fracture risk, particularly in obese elderly women, suggests limitations in BMD-focused assessments. Simple, measurable parameters like age and BMI should complement BMD in fracture risk evaluation to better target high-risk populations and enhance preventive strategies in clinical practice.
绝经后女性的骨折风险受骨密度（BMD）、年龄和体重指数（BMI）影响。然而，骨折预防策略主要侧重于低骨密度，常常忽视其他关键因素。
这项回顾性队列研究分析了2006年至2014年在阿朱大学医院接受双能X线吸收法（DXA）检查的18151名年龄在50岁及以上的韩国绝经后女性。使用多变量Cox比例风险模型评估骨折风险，并对BMI、BMD和年龄进行了调整。
该队列的中位年龄为59.1岁，总体骨折发生率为每1000人年2.3例。骨折风险随年龄显著增加，与参考组（50 - 59岁）相比，60 - 69岁女性的风险比（HR）为1.36（95%CI：1.08 - 1.70），70岁及以上女性为2.10（95%CI：1.62 - 2.73）。体重过轻的女性骨折累积发生率最高（3.3%），尽管其风险增加无统计学意义。超重和肥胖女性骨密度较高，但骨折风险并未显著降低。
这些发现突出了年龄是骨折风险的主要预测因素，而BMI的作用复杂且不那么明显。骨质疏松症患病率与实际骨折风险之间的差异，尤其是在肥胖老年女性中，表明以骨密度为重点的评估存在局限性。年龄和BMI等简单可测量参数应在骨折风险评估中补充骨密度，以便更好地针对高危人群并加强临床实践中的预防策略。
