Predicting fragility fractures based on frailty and bone mineral density among rural community-dwelling older adults.

IF 5.3 1区医学 Q1 ENDOCRINOLOGY & METABOLISM European Journal of Endocrinology Pub Date : 2024-07-02 DOI:10.1093/ejendo/lvae080

Jeongmin Lee, Jinyoung Kim, Chaiho Jeong, Jeonghoon Ha, Yejee Lim, Ki-Hyun Baek

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Abstract

Objective: We aim to investigate the association between bone mineral density (BMD) measurement and fragility fractures and assess the predictive value of combining BMD measurement and frailty for fracture risk assessment.

Methods: This retrospective cohort study analyzed data from 5126 rural Koreans in the Chungju Metabolic Disease Cohort study. Frailty was defined using Fried's frailty phenotype. Fractures were assessed via structured medical interviews. Adjusted odds ratios (ORs) were calculated considering age, sex, body mass index, behavior, BMD, handgrip strength, medications, and comorbidities.

Results: The study cohort consisted of 5126 participants comprising 1955 (38.1%) males and 3171 (61.9%) females. Osteoporosis significantly increased the fracture risk across all types, except vertebral fracture, with adjusted OR (95% CI) of 1.89 (1.23-3.47) for any fracture, 2.05 (1.37-2.98) for hip fracture, 2.18 (1.06-4.50) for other fracture, and 1.71 (1.03-3.63) for major osteoporotic fracture (MOF). Frail individuals exhibited significantly increased risk for any fracture (OR 2.12; 95% CI, 1.21-3.71), vertebral fracture (2.48; 1.84-3.61), hip fracture (2.52; 1.09-3.21), other fracture (2.82; 1.19-8.53), and MOF (1.87; 1.01-3.47). The combination of frailty and BMD further increased the risks, with frail individuals demonstrating elevated ORs across BMD categories. In subgroup analyses, men showed a significant association between frailty with osteoporosis in hip fracture and MOF. Frail women with osteoporosis exhibited the highest risks for all fractures, particularly vertebral (OR 5.12; 95% CI, 2.07-9.68) and MOF (OR 5.19; 95% CI, 2.07-6.61). Age-specific analysis revealed that individuals aged 70 and older exhibited markedly higher fracture risks compared with those under 70. The combination of frailty and low BMD further elevated the fracture risk. Frailty was applied with BMD and demonstrated superior risk prediction for MOF compared with that with either score alone (area under the curve 0.825; P = .000).

Conclusions: Combining frailty with BMD provides a more accurate fracture risk assessment for individuals over 50 years.

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根据虚弱程度和 BMD 预测农村社区老年人的脆性骨折。

目的我们旨在研究骨矿物质密度（BMD）测量与脆性骨折之间的关联，并评估结合 BMD 测量和虚弱程度进行骨折风险评估的预测价值：这项回顾性队列研究分析了忠州代谢性疾病队列研究中 5126 名韩国农村居民的数据。采用弗里德的虚弱表型对虚弱进行定义。骨折情况通过结构化医疗访谈进行评估。计算调整后的几率比（OR）时考虑了年龄、性别、体重指数、行为、BMD、手握力、药物和合并症等因素：研究队列由 5126 名参与者组成，其中男性 1955 人（占 38.1%），女性 3171 人（占 61.9%）。除脊椎骨折外，骨质疏松症会明显增加所有类型骨折的风险，任何骨折的调整OR值（95%置信区间，CI）为1.89（1.23-3.47），髋部骨折为2.05（1.37-2.98），其他骨折为2.18（1.06-4.50），MOF为1.71（1.03-3.63）。体弱者发生任何骨折（OR 2.12，95% CI，1.21-3.71）、椎体骨折（2.48，1.84-3.61）、髋部骨折（2.52，1.09-3.21）、其他骨折（2.82，1.19-8.53）和 MOF（1.87，1.01-3.47）的风险均明显增加。虚弱与 BMD 的结合进一步增加了风险，虚弱的人在不同的 BMD 类别中都显示出较高的 ORs。在亚组分析中，男性在髋部骨折和MOF中显示出虚弱与骨质疏松症之间的显著关联。患有骨质疏松症的虚弱女性发生所有骨折的风险最高，尤其是椎体骨折（OR 5.12，95% CI 2.07-9.68）和MOF骨折（OR 5.19，95% CI 2.07-6.61）。针对不同年龄段的分析显示，70 岁及以上人群的骨折风险明显高于 70 岁以下人群。虚弱和低 BMD 的组合进一步增加了骨折风险。将虚弱与 BMD 结合使用，对 MOF 的风险预测优于单独使用其中一种评分（AUC 0.825，P = 0.000）：结论：将虚弱程度与 BMD 结合使用，可对 50 岁以上人群进行更准确的骨折风险评估。

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

European Journal of Endocrinology 医学-内分泌学与代谢

CiteScore

9.80

自引率

3.40%

发文量

354

审稿时长

1 months

期刊介绍： European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.