Lips P
Department of Endocrinology, Academic Hospital, Vrije Universiteit, Amsterdam, The Netherlands.
Am J Med. 1997 Aug 18;103(2A):3S-8S; discussion 8S-11S. doi: 10.1016/s0002-9343(97)90021-8.
Approximately 40 in 100 women will experience one or more fractures after the age of 50 years. At 50 years for women the lifetime risk is 17.5% for hip fracture, 16% for vertebral fracture, and 16% for Colles' fracture; for men, the respective lifetime risks are 6%, 5%, and 2.5%. The incidence of hip fractures has increased in recent years in most but not all European countries, partly as a result of the aging of the population. However, the age-adjusted incidence has also increased in several countries. The age-adjusted incidence of hip fractures varies greatly between European countries; in women incidence varies from about 50 per 10,000 women in Malta and Poland to 500 per 10,000 in Sweden. In addition, the sex ratio (female:male) varies from 1.6 in Poland to 4.2 in Iceland. A proportion of this large variation may be the result of underreporting of cases, although most European countries now have an adequate hospital registration. The prevalence of vertebral deformities also shows geographic variation. In the multinational European Vertebral Osteoporosis Study, a population-based study, the prevalence of vertebral deformities was similar among men and women at ages 65-69 years (12-13%); at younger ages the prevalence was higher in men than women, whereas the reverse was true at older ages. Incidence data on vertebral fractures are scarce because a large proportion of vertebral fractures are not clinically diagnosed. Prospective epidemiologic studies indicate that bone mineral density (BMD) is the single best predictor of fractures in perimenopausal women. Historic risk factors do not predict bone mass (or fractures) with sufficient precision to be useful in assessment of fracture risk or BMD. However, the presence of one vertebral fracture doubles the risk of future vertebral fracture as assessed by a BMD measurement. At advanced ages, other risk factors may be more important, such as the risk of falling, and combinations of risk factors for falls and low BMD may predict hip fractures. Risk factor assessment is currently of less value for the prediction of other fractures, such as vertebral or Colles' fracture. Determining the causes of the large geographic differences in hip fracture incidence and the large differences in sex ratios for hip fractures in European countries could lead to identification of hitherto unknown risk factors and provide clues for prevention of fractures. Many risk factors cannot be prevented or modified; however, these risk factors (for example, family history, past fracture, and visual loss) can identify risk groups amenable to drug treatment or to preventive measures such as protective hip pads or environmental changes. Assessment of risk factors and definition of risk profiles are important steps toward the prevention of fractures in the elderly.
约每100名女性中，有40人在50岁后会经历一次或多次骨折。50岁女性发生髋部骨折的终生风险为17.5%，椎体骨折为16%，Colles骨折为16%；男性相应的终生风险分别为6%、5%和2.5%。近年来，大多数（但并非所有）欧洲国家髋部骨折的发病率有所上升，部分原因是人口老龄化。然而，一些国家的年龄标准化发病率也有所上升。欧洲国家之间髋部骨折的年龄标准化发病率差异很大；女性发病率从马耳他和波兰每10000名女性约50例到瑞典的每10000名女性500例不等。此外，性别比（女性：男性）从波兰的1.6到冰岛的4.2不等。这种巨大差异的一部分可能是病例报告不足的结果，尽管现在大多数欧洲国家都有完善的医院登记制度。椎体畸形的患病率也存在地理差异。在一项基于人群的多民族欧洲椎体骨质疏松症研究中，65 - 69岁男性和女性的椎体畸形患病率相似（12 - 13%）；在较年轻年龄段，男性患病率高于女性，而在较年长年龄段则相反。椎体骨折的发病率数据稀缺，因为很大一部分椎体骨折没有得到临床诊断。前瞻性流行病学研究表明，骨密度（BMD）是围绝经期女性骨折的最佳单一预测指标。既往风险因素对骨量（或骨折）的预测精度不足以用于评估骨折风险或骨密度。然而，通过骨密度测量评估，发生一次椎体骨折会使未来椎体骨折的风险加倍。在高龄时，其他风险因素可能更重要，如跌倒风险，跌倒风险因素与低骨密度的组合可能预测髋部骨折。目前风险因素评估对预测其他骨折（如椎体骨折或Colles骨折）的价值较小。确定欧洲国家髋部骨折发病率的巨大地理差异以及髋部骨折性别比差异的原因，可能会发现迄今未知的风险因素，并为骨折预防提供线索。许多风险因素无法预防或改变；然而，这些风险因素（例如家族史、既往骨折和视力丧失）可以识别适合药物治疗或采取诸如保护性髋部护垫或环境改变等预防措施的风险人群。评估风险因素和定义风险概况是预防老年人骨折的重要步骤。
