Refractures in Patients at Least Forty-five Years Old: A Prospective Analysis of Twenty-two Thousand and Sixty Patients

C. Robinson, M. Royds, A. Abraham, M. McQueen, C. Court-Brown, J. Christie
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引用次数: 111

Abstract

Background: Individuals who sustain a low-energy fracture are at increased risk of sustaining a subsequent low-energy fracture. The incidence of these refractures may be reduced by secondary preventative measures, although justifying such interventions and evaluating their impact is difficult without substantive evidence of the severity of the refracture risk. The aim of this study was to quantify the risk of sustaining another fracture following a low-energy fracture compared with the risk in an age and sex-matched reference population.Methods: During the twelve-year period between January 1988 and December 1999, all inpatient and outpatient fracture-treatment events were prospectively audited in a trauma unit that is the sole source of fracture treatment for a well-defined local catchment population. During this time, 22,060 patients at least forty-five years of age who had sustained a total of 22,494 low-energy fractures of the hip, wrist, proximal part of the humerus, or ankle were identified. All refracture events were linked to the index fracture in the database during the twelve-year period. The incidence of refracture in the cohort of patients who had sustained a previous fracture was divided by the "background" incidence of index fractures within the same local population to obtain the relative risk of refracture. Person-years at-risk methodology was used to control for the effect of the expected increase in mortality with advancing age.Results: Within the cohort, 2913 patients (13.2%) subsequently sustained a total of 3024 refractures during the twelve-year period. Patients with a previous low-energy fracture had a relative risk of 3.89 of sustaining a subsequent low-energy fracture. The relative risk was significantly increased for both sexes, but it was greater for men (relative risk = 5.55) than it was for women (relative risk = 2.94). The relative risk was 5.23 in the youngest age cohort (patients between forty-five and forty-nine years of age), and it decreased with increasing age to 1.20 in the oldest cohort (patients at least eighty-five years of age).Conclusions: Individuals who sustain a low-energy fracture between the ages of forty-five and eighty-four years have an increased relative risk of sustaining another low-energy fracture. This increased risk was greater when the index fracture occurred earlier in life; the risk decreased with advancing age. Secondary preventative measures designed to reduce the risk of refracture following a low-energy fracture are likely to have a greater impact on younger individuals.
45岁以上患者的再发:22,60例患者的前瞻性分析
背景:低能性骨折患者发生后续低能性骨折的风险增加。这些再骨折的发生率可以通过二级预防措施来降低,尽管在没有再骨折风险严重程度的实质性证据的情况下,很难证明这些干预措施的有效性并评估其影响。本研究的目的是量化低能量骨折后再次骨折的风险,并与年龄和性别匹配的参考人群进行比较。方法:在1988年1月至1999年12月的12年期间,所有住院和门诊的骨折治疗事件都在创伤病房进行前瞻性审计,创伤病房是骨折治疗的唯一来源,为明确的当地集水人群提供治疗。在此期间,共有22,060名45岁以上的患者被确定为髋部、腕部、肱骨近端或踝关节的22,494例低能量骨折。在12年期间,所有的再骨折事件都与数据库中的指数骨折相关联。既往骨折患者的再骨折发生率除以同一当地人群中指数骨折的“背景”发生率,以获得再骨折的相对风险。使用人-年风险方法学来控制随年龄增长预期死亡率增加的影响。结果:在该队列中,2913例患者(13.2%)随后在12年期间共持续3024次复发。先前发生过低能骨折的患者发生后续低能骨折的相对风险为3.89。两性的相对风险都显著增加,但男性的相对风险(相对风险= 5.55)高于女性(相对风险= 2.94)。相对危险度在年龄最小的队列(45 - 49岁)中为5.23,在年龄最大的队列(至少85岁)中为1.20,随着年龄的增加而降低。结论:45岁至84岁之间发生低能骨折的个体发生另一次低能骨折的相对风险增加。当指数骨折发生在生命早期时,这种风险增加更大;风险随着年龄的增长而降低。旨在降低低能骨折后再骨折风险的二级预防措施可能对年轻人有更大的影响。
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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