After the initial fracture in postmenopausal women, where do subsequent fractures occur?
| Autor: | Crandall CJ; Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, 1100 Glendon Ave. Suite 850 - Room 858, Los Angeles, CA 90024, United States., Hunt RP; WHI Clinical Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, WA, United States., LaCroix AZ; Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, San Diego, CA, United States., Robbins JA; Department of Medicine, UC Davis Medical Center, Sacramento, CA, United States., Wactawski-Wende J; Department of Epidemiology and Environmental Health, University at Buffalo the State University of New York, Buffalo, NY, United States., Johnson KC; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States., Sattari M; Division of General Internal Medicine, University of Florida, Gainesville, FL, United States., Stone KL; California Pacific Medical Center Research Institute, San Francisco Coordinating Center, San Francisco, CA, United States., Weitlauf JC; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States., Gure TR; Division of General Internal Medicine & Geriatrics, The Ohio State University, Columbus, OH, United States., Cauley JA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States. |
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| Jazyk: | angličtina |
| Zdroj: | EClinicalMedicine [EClinicalMedicine] 2021 May 05; Vol. 35, pp. 100826. Date of Electronic Publication: 2021 May 05 (Print Publication: 2021). |
| DOI: | 10.1016/j.eclinm.2021.100826 |
| Abstrakt: | Background: The locations of subsequent fractures after initial fracture in postmenopausal women are poorly characterized. Methods: We conducted a prospective analysis of subsequent fractures after initial fracture in Women's Health Initiative (1993-2018) participants who provided follow-up (mean 15.4 years, SD 6.2 years) data ( n = 157,282 participants; baseline age 50-79; 47,458 participants with incident fracture). Cox proportional hazards models were adjusted for age, race/ethnicity, body mass index, and other covariates. Findings: The risk of each type of subsequent fracture was increased after each type of initial fracture. Incident lower arm/wrist fracture was associated with significantly elevated risks of subsequent fractures at the upper arm/shoulder, upper leg, knee, lower leg/ankle, hip/pelvis, and spine (adjusted hazard ratios [aHRs] ranging 2·63-5·68). The risk of hip fracture was increased after initial lower arm or wrist fracture (aHR 4·80, 95% CI 4·29-5·36), initial upper arm or shoulder fracture (aHR 5·06, 95% CI 4·39-5·82), initial upper leg fracture (aHR 5·11, 95% CI 3·91-6·67), initial knee fracture (aHR 5·03, 95% CI 4·20-6·03), initial lower leg/ankle fracture (aHR 4·10, 95% CI 3·58-4·68), and initial spine fracture (aHR 6·69, 95% CI 5·95-7·53). Associations were significant in all age groups, even women aged 50-59 years. Risks of subsequent fracture were more pronounced among non-Hispanic Black, Hispanic/Latina, and Asian/Pacific Islander than among non-Hispanic White women. Interpretation: Increased risk of subsequent fracture is observed for all fracture types across all ages. Women who experience any of these fractures should be targeted for interventions to prevent subsequent fractures. Funding: National Institutes of Health HHSN268201600018C,HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C. Competing Interests: TG reports grants from National Heart, Lung, and Blood Institute, during the conduct of the study. RH reports grants from NHLBI, during the conduct of the study. KJ reports grants from NIH, during the conduct of the study. AL reports grants from National Institutes of Health, NHLBI, during the conduct of the study. KS reports grants from Merck & Co., outside the submitted work. JW-W reports grants from NHLBI, during the conduct of the study. MS reports grants from American Cancer Society, grants from The Centers for Disease Control and Prevention, grants from Florida Department of Health, outside the submitted work. The other authors have nothing to disclose. (© 2021 The Authors.) |
| Databáze: | MEDLINE |
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