Jones G, Nguyen T, Sambrook P N, Lord S R, Kelly P J, Eisman J A
Garvan Institute of Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, Australia.
J Rheumatol. 1995 May;22(5):921-5.
Osteoarthritis (OA) is associated with an increase in bone density both locally and at distant sites. Prospective data are limited on the relationship between OA and fracture. We studied the possible relationship between self-reported OA, bone density, postural stability measures, and atraumatic fractures as part of a study of men and women over 60 years of age.
Subjects were part of the Dubbo Osteoporosis Epidemiology Study (a longitudinal population based study of fracture risk factors). Bone density was measured by dual energy x-ray absorptiometry. Postural stability was assessed by the validated measures of quadriceps strength and sway. Medication use and self-reported arthritis were assessed by a structured personal interview. Fractures were ascertained retrospectively by interview and prospectively by viewing radiographic reports for fracture.
Among a study population of 1101 women and 720 men (mean age 69) there were 462 subjects (25%) who reported a diagnosis of OA. In both sexes, subjects with OA had higher bone density (adjusted for age and body mass index) at both the femoral neck (men, p = 0.026; women, p = 0.048) and lumbar spine (men, p = 0.0007; women, p = 0.0007). However, in both sexes, those with self-reported OA also had higher body sway and lower quadriceps strength. The combination of these observed differences in fracture risk factors led to no predicted change in fracture risk overall when using established nomograms for this population [men, OR = 1.11 (95% CI 0.83-1.45); women, OR = 1.08 (95% CI 0.83-1.39)]. This paralleled our observational finding that self-reported OA was not associated with a decrease in fracture incidence compared to those not reporting OA in both men (RR 0.64, 95% CI 0.29-1.39) and women (RR 1.00, 95% CI 0.66-1.51).
Individuals with self-reported OA, despite higher bone density, are not protected against nonvertebral osteoporotic fracture, apparently due to worsened postural stability and thus an increased tendency to fall.
骨关节炎（OA）与局部及远处骨密度增加有关。关于OA与骨折之间关系的前瞻性数据有限。作为一项针对60岁以上男性和女性的研究的一部分，我们研究了自我报告的OA、骨密度、姿势稳定性指标与非创伤性骨折之间的可能关系。
受试者是Dubbo骨质疏松症流行病学研究的一部分（一项基于人群的骨折风险因素纵向研究）。通过双能X线吸收法测量骨密度。通过验证的股四头肌力量和摇摆测量来评估姿势稳定性。通过结构化的个人访谈评估药物使用情况和自我报告的关节炎。通过访谈回顾性确定骨折情况，并通过查看骨折的X线报告前瞻性确定骨折情况。
在1101名女性和720名男性（平均年龄69岁）的研究人群中，有462名受试者（25%）报告诊断为OA。在男女两性中，患有OA的受试者在股骨颈（男性，p = 0.026；女性，p = 0.048）和腰椎（男性，p = 0.0007；女性，p = 0.0007）的骨密度均较高（根据年龄和体重指数进行调整）。然而，在男女两性中，自我报告患有OA的人身体摇摆也更大，股四头肌力量更低。当使用针对该人群的既定列线图时，这些观察到的骨折风险因素差异的组合并未导致总体骨折风险的预测变化[男性，OR = 1.11（95%CI 0.83 - 1.45）；女性，OR = 1.08（95%CI 0.83 - 1.39）]。这与我们的观察结果一致，即与未报告OA的人相比，自我报告患有OA的男性（RR 0.64，95%CI 0.29 - 1.39）和女性（RR 1.00，95%CI 0.66 - 1.51）骨折发生率并未降低。
自我报告患有OA的个体，尽管骨密度较高，但并未免受非椎体骨质疏松性骨折的影响，显然是由于姿势稳定性恶化，从而增加了跌倒倾向。
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