Johansson C, Mellström D
Department of Geriatric Medicine, Vasa Hospital, University of Gothenburg, Sweden.
Maturitas. 1996 May;24(1-2):97-106. doi: 10.1016/0378-5122(95)01024-6.
The purpose of this study was to investigate whether a previous fracture is a risk factor for fracture later in life and its association with tobacco smoking, menopausal age and the use of oral contraceptives. This is an epidemiological population study based on a questionnaire. A sample of 10000 women from seven birth cohorts between 1900-1940 was obtained at random from the population register. The overall response rate was 74.6%. The responders (n = 7459) represented 53% of the total population.
The women from all these birth cohorts were questioned regarding a possible history of fractures and the year in which they were sustained. The questionnaire also included questions about menopausal age, use of oral contraceptives, previous gynaecological operations and possible oestrogen medication. The women from the 1900-1920 birth cohorts were questioned in detail about urogenital disorders, while tobacco smoking data were recorded only for the 1930 and 1940 birth cohorts.
The relative risk of sustaining a further fracture was significantly related to fracture premenopausally before 40 years of age and later fracture postmenopausally after 60 years of age (1.29; 0.97-1.70) compared to controls (0.78; 0.59-1.03)(P = 0.03). Both an early menopause and tobacco smoking were associated significantly with repeated fractures, while use of oral contraceptives had a protective effect against repeated fractures in the 1940 birth cohort. Logistic multiple regression showed that a fracture was a significant independent risk factor for further fracture in both cohorts 1900-1920 (P < 0.01) and 1930-1940 (P < 0.05).
This study suggests poorer protective resources against new fractures among women with previous fractures, and that lack of oestrogen menopausally can partly explain the enhanced risk of fracture, not only during the menopause but also later in life when a hip fracture may have immense consequences. The results should draw our attention to emphasise the need for active treatment of patients with established osteoporosis because of the increased risk of new fractures later in life.
本研究旨在调查既往骨折是否为日后发生骨折的危险因素，及其与吸烟、绝经年龄和口服避孕药使用之间的关联。这是一项基于问卷调查的流行病学人群研究。从人口登记册中随机抽取了1900年至1940年间七个出生队列中的10000名女性作为样本。总体回复率为74.6%。回复者（n = 7459）占总人口的53%。
对所有这些出生队列中的女性询问了可能的骨折病史以及骨折发生年份。问卷还包括有关绝经年龄、口服避孕药使用情况、既往妇科手术以及可能的雌激素用药情况的问题。对1900年至1920年出生队列中的女性详细询问了泌尿生殖系统疾病，而仅记录了1930年和1940年出生队列中的吸烟数据。
与对照组相比，40岁之前绝经前发生骨折以及60岁之后绝经后发生骨折的女性再次发生骨折的相对风险显著相关（1.29；0.97 - 1.70），而对照组为（0.78；0.59 - 1.03）（P = 0.03）。绝经早和吸烟均与反复骨折显著相关, 而在1940年出生队列中，口服避孕药对反复骨折有保护作用。逻辑多元回归显示，骨折是1900年至1920年队列（P < 0.01）和1930年至1940年队列（P < 0.05）中再次发生骨折的显著独立危险因素。
本研究表明，既往有骨折的女性对新骨折的保护资源较差，绝经时雌激素缺乏可部分解释骨折风险增加，不仅在绝经期间，而且在晚年髋部骨折可能产生巨大后果时。这些结果应引起我们的注意，强调对于已确诊骨质疏松症的患者进行积极治疗的必要性，因为其晚年发生新骨折的风险增加。
