Summary

Prior high-trauma fractures identified through health services data are associated with low bone mineral density (BMD) and future fracture risk to the same extent as fractures without high-trauma.

Introduction

Some have questioned the usefulness of distinguishing high-trauma fractures from low-trauma fractures. The aim of this study is to compare BMD measurements and risk of subsequent low-trauma fracture in patients with prior high- or low-trauma fractures.

Methods

Using a clinical BMD registry for the province of Manitoba, Canada, we identified women and men age 40 years or older with fracture records from linked population-based healthcare data. Age- and sex-adjusted BMD Z-scores and covariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident fracture were studied in relation to prior fracture status, categorized as high-trauma if associated with external injury codes and low-trauma otherwise.

Results

The study population consisted of 64,428 women and men with no prior fracture (mean age 63.7 years), 858 with prior high-trauma fractures (mean age 65.1 years), and 14,758 with prior low-trauma fractures (mean age 67.2 years). Mean Z-scores for those with any prior high-trauma fracture were significantly lower than in those without prior fracture (P < 0.001) and similar to those with prior low-trauma fracture. Median observation time for incident fractures was 8.8 years (total 729,069 person-years). Any prior high-trauma fracture was significantly associated with increased risk for incident major osteoporotic fracture (MOF) (adjusted HR 1.31, 95% CI 1.08–1.59) as was prior low-trauma fracture (adjusted HR 1.55, 95% CI 1.47–1.63), and there was no significant difference between the two groups (prior trauma versus low-trauma fracture P = 0.093). A similar pattern was seen when incident MOF was studied in relation to prior hip fracture or prior MOF, or when the outcome was incident hip fracture or any incident fracture.

Conclusions

High-trauma and low-trauma fractures showed similar relationships with low BMD and future fracture risk. This supports the inclusion of high-trauma fractures in clinical assessment for underlying osteoporosis and in the evaluation for intervention to reduce future fracture risk.

中文翻译：

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高创伤与低创伤骨折后的骨折风险：一项基于注册表的队列研究

概要

通过卫生服务数据确定的先前的高创伤性骨折与低骨矿物质密度（BMD）和未来的骨折风险相关，程度与无高创伤性骨折相同。

介绍

一些人质疑区分高创伤性骨折和低创伤性骨折的有用性。这项研究的目的是比较先前有高创伤或低创伤骨折的患者的BMD测量值和随后发生低创伤骨折的风险。

方法

使用加拿大曼尼托巴省的临床BMD注册中心，我们从基于人群的医疗数据链接中识别出40岁或40岁以上的男性和女性具有骨折记录。研究了与先前骨折状况相关的年龄和性别调整后的BMD Z评分以及协变量调整后的危险比（HR）与95％置信区间（CI）的相关性，如果与外部伤害代码相关，则归为高创伤和低创伤否则。

结果

研究人群包括64,428名既往无骨折（平均年龄63.7岁）的男女，858名既往发生高创伤性骨折（平均年龄65.1岁），以及14,758名既往发生低创伤的骨折（平均年龄67.2岁）。既往有高创伤骨折者的平均Z得分显着低于无先兆骨折者（P <0.001），与先前有低创伤骨折的患者相似。事故性骨折的观察时间中位数为8.8年（总计729,069人年）。任何先前的高创伤性骨折与发生重大骨质疏松性骨折（MOF）的风险增加（校正后的HR 1.31，95％CI 1.08–1.59）显着相关，就像先前的低创伤性骨折（校正后的HR 1.55，95％CI 1.47–1.63） ），两组之间的差异无统计学意义（创伤前与低创伤骨折之间P  = 0.093）。当研究与先前的髋部骨折或先前的MOF相关的入射MOF时，或者当结果为入射髋部骨折或任何入射骨折时，也观察到类似的模式。

结论

高创伤和低创伤骨折与低骨密度和未来骨折风险显示出相似的关系。这支持将高创伤骨折纳入潜在骨质疏松症的临床评估中，并纳入降低未来骨折风险的干预评估中。