Age at First Fracture and Later Fracture Risk in Older Adults Undergoing Osteoporosis Assessment.

IF 10.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Carrie Ye, Suzanne N Morin, Lisa M Lix, Eugene V McCloskey, Helena Johansson, Nicholas C Harvey, John A Kanis, William D Leslie
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引用次数: 0

Abstract

Importance: Fragility fractures are often defined as those that occur after a certain age (eg, 40-50 years). Whether fractures occurring in early adulthood are equally associated with future fractures is unclear.

Objective: To examine whether the age at which a prior fracture occurred is associated with future fracture risk.

Design, setting, and participants: This observational, population-based cohort study included individuals from the Manitoba Bone Mineral Density Registry with a first bone mineral density (BMD) measurement between January 1, 1996, and March 31, 2018, with and without prior fracture in adulthood. Data analysis was completed between April 1, and May 31, 2023.

Exposure: Individuals with fractures before their first dual-energy x-ray absorptiometry were stratified by the age at first fracture (10-year intervals from 20-29 to ≥80 years of age).

Main outcomes and measures: Incident fractures occurring after dual-energy x-ray absorptiometry (index date) and before March 31, 2021, were identified using linked provincial administrative health data.

Results: The cohort included 88 696 individuals (80 066 [90.3%] female; mean [SD] age, 64.6 [11.0] years) with a mean (SD) femoral neck T score of -1.4 (1.0). A total of 21 105 individuals (23.8%) had sustained a prior fracture at a mean (SD) age of 57.7 (13.6) years (range, 20.0-102.4 years) at the time of first prior fracture. During a mean (SD) of 9.0 (5.5) years of follow-up, incident fractures occurred in 13 239 individuals (14.6%), including 12 425 osteoporotic fractures (14.0%), 9440 major osteoporotic fractures (MOFs) (10.6%), and 3068 hip fractures (3.5%). The sex- and age-adjusted hazard ratios for all incident fractures, osteoporotic fractures, and MOFs, according to age at first fracture, were all significantly elevated, with point estimates ranging from 1.55 (95% CI, 1.28-1.88) to 4.07 (95% CI, 2.99-5.52). After adjusting for the additional covariates, the effect estimates were similar and remained significantly elevated, with point estimates ranging from fully adjusted hazard ratios of 1.51 (95% CI, 1.42-1.60) to 2.12 (95% CI, 1.67-2.71) across age categories. Sensitivity analyses examining age at last prior fracture and in those with multiple prior fractures showed similar results.

Conclusions and relevance: In this cohort study, fractures in adulthood were associated with future fractures regardless of the age at which they occurred. Thus, fractures in early adulthood should not be excluded when assessing an individual's ongoing fracture risk.

在接受骨质疏松评估的老年人中,首次骨折的年龄和后来的骨折风险。
重要性:脆性骨折通常定义为发生在一定年龄(如40-50岁)之后的骨折。成年早期发生的骨折是否与未来的骨折同样相关尚不清楚。目的:探讨既往骨折发生的年龄是否与未来骨折风险相关。设计、环境和参与者:这项基于人群的观察性队列研究纳入了1996年1月1日至2018年3月31日期间马尼托巴骨矿物质密度登记处首次测量骨矿物质密度(BMD)的个体,成年期有或没有骨折。数据分析于2023年4月1日至5月31日完成。暴露:首次接受双能x线骨密度测量的骨折患者按首次骨折年龄分层(20-29岁至≥80岁,间隔10年)。主要结果和措施:使用相关的省级行政卫生数据确定在双能x线吸收仪(指数日期)之后和2021年3月31日之前发生的偶发性骨折。结果:队列纳入88 696例(女性80 066例[90.3%];平均[SD]年龄64.6[11.0]岁),平均(SD)股骨颈T评分-1.4(1.0)。共有21 105人(23.8%)在首次骨折时经历过骨折,平均(SD)年龄为57.7(13.6)岁(范围为20.0-102.4岁)。在平均(SD) 9.0(5.5)年的随访期间,13 239例(14.6%)发生意外骨折,其中12 425例骨质疏松性骨折(14.0%),9440例重度骨质疏松性骨折(10.6%)和3068例髋部骨折(3.5%)。根据首次骨折的年龄,所有骨折、骨质疏松性骨折和mof的性别和年龄调整后的危险比均显著升高,点估计范围为1.55 (95% CI, 1.28-1.88)至4.07 (95% CI, 2.99-5.52)。在调整了额外的协变量后,效果估计值是相似的,并且仍然显著升高,在不同年龄类别中,点估计值从完全调整的风险比1.51 (95% CI, 1.42-1.60)到2.12 (95% CI, 1.67-2.71)不等。敏感性分析显示,年龄最后一次骨折和多次骨折的敏感性分析结果相似。结论和相关性:在这项队列研究中,成年期骨折与未来骨折的发生年龄无关。因此,在评估个体持续骨折风险时,不应排除成年早期骨折。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JAMA Network Open
JAMA Network Open Medicine-General Medicine
CiteScore
16.00
自引率
2.90%
发文量
2126
审稿时长
16 weeks
期刊介绍: JAMA Network Open, a member of the esteemed JAMA Network, stands as an international, peer-reviewed, open-access general medical journal.The publication is dedicated to disseminating research across various health disciplines and countries, encompassing clinical care, innovation in health care, health policy, and global health. JAMA Network Open caters to clinicians, investigators, and policymakers, providing a platform for valuable insights and advancements in the medical field. As part of the JAMA Network, a consortium of peer-reviewed general medical and specialty publications, JAMA Network Open contributes to the collective knowledge and understanding within the medical community.
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