Long-term risk of incident vertebral fractures

被引:187
作者
Cauley, Jane A.
Hochberg, Marc C.
Lui, Li-Yung
Palermo, Lisa
Ensrud, Kristine E.
Hillier, Teresa A.
Nevitt, Michael C.
Cummings, Steven R.
机构
[1] Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA
[2] Univ Maryland, Med Ctr, Dept Med, Baltimore, MD 21201 USA
[3] Calif Pacific Med Ctr, San Francisco Coordinating Ctr, San Francisco, CA USA
[4] Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[5] Minneapolis VA Med Ctr, Dept Med, Minneapolis, MN USA
[6] Kaiser Permanente Ctr Hlth Res NW Hawaii, Portland, OR USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2007年 / 298卷 / 23期
关键词
D O I
10.1001/jama.298.23.2761
中图分类号
R5 [内科学];
学科分类号
1002 [临床医学]; 100201 [内科学];
摘要
Context Vertebral fractures are the most common osteoporotic fracture. Women with low bone mineral density ( BMD) and prevalent vertebral fractures have a greater risk of incident vertebral fractures over the short- term, but their absolute risk of vertebral fracture over the long- term is uncertain. Objective To examine the absolute risk of incident vertebral fracture by BMD and prevalent vertebral fracture status over 15 years. Design, Setting, and Participants A total of 9704 white women were recruited at 4 US clinical centers and enrolled in the Study of Osteoporotic Fractures, a longitudinal cohort study. Of these, 2680 attended a clinic visit an average of 14.9 years after baseline; mean age of 68.8 years at entry and 83.8 years at follow- up. Mean Outcome Measure Incident vertebral fractures identified from lateral spinal radiographs defined as a decrease of at least 20% and 4 mm at any vertebral level. Prevalent vertebral fractures were identified on the baseline radiographs using vertebral morphometry. Bone mineral density was measured at the total hip and lumbar spine using dual- energy x- ray absorptiometry. Results Of the 2680 women, 487 ( 18.2%) had an incident vertebral fracture including 163 of the 394 ( 41.4%) with a prevalent vertebral fracture at baseline and 324 of the 2286 ( 14.2%) without a prevalent vertebral fracture at baseline ( odds ratio, 4.21; 95% confidence interval, 3.33- 5.34). Low BMD was associated with an increased risk of incident vertebral fracture ( odds ratio per 1 SD decrease in total hip BMD, 1.78 [ 95% confidence interval, 1.58- 2.00]). The absolute risk of vertebral fracture ranged from 56% among women with total hip BMD T score of - 2.5 or less and a prevalent vertebral fracture to 9% in women with normal BMD and no prevalent vertebral fracture. Conclusions Low BMD and prevalent vertebral fractures are independently related to new vertebral fractures over 15 years of follow- up. Women with a prevalent vertebral fracture have a substantially increased absolute risk of an incident fracture, especially if they have osteoporosis diagnosed by BMD.
引用
收藏
页码:2761 / 2767
页数:7
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