Gaceta Sanitaria (Dec 2011)
Factores de riesgo de fracturas por fragilidad en una cohorte de mujeres españolas Risk factors for fragility fractures in a cohort of Spanish women
Abstract
Introducción: Las fracturas por fragilidad constituyen un problema de salud pública. El objetivo fue analizar la asociación de los principales factores de riesgo de osteoporosis con la fracturas por fragilidad en una cohorte de mujeres con indicación de densitometría ósea. Métodos: Cohorte retrospectiva con seguimiento hasta una fractura por fragilidad, de una población de mujeres de 40 a 90 años de edad con una primera visita para realizarse una densitometría entre enero de 1992 y febrero de 2008. Se calcularon la tasa de incidencia de fracturas por 1000 mujeres-año de seguimiento y la hazard ratio (HR) de fractura mediante un modelo de regresión de Cox. Resultados: Se estudiaron 49.735 mujeres con una edad media de 57,8 años (desviación estándar: 8,5). De ellas, 3631 mujeres (7,1%) declararon al menos una fractura por fragilidad en las visitas posteriores a la basal. Los factores de riesgo con una mayor HR ajustada fueron la edad >75 años respecto a Introduction: Fragility fractures are an important public health issue. The aim of this study was to analyze the association of the main osteoporotic risk factors related to fragility fracture in a cohort of women with an indication of bone densitometry (BD). Methods: A retrospective cohort was followed-up until a fragile fracture occurred, in a population of women aged 40 to 90 years with a first visit for BD between January 1992 and February 2008. We calculated the incidence rate of fracture per 1000 women-years of follow-up, and the hazard ratio (HR) of fragile fracture using a Cox regression model. Results: A total of 49,735 women were studied. The average age of participants was 57.8 years (SD: 8.5). Of these, 3631 women (7.1%) reported a new fragility fracture in post-baseline visits. Risk factors with higher adjusted HR were age > 75 years compared with age < 55 years (HR: 3.8; 95% CI: 3.3-4.4) and having a BC result evaluated as osteoporosis compared to normal (HR: 2.0; 95% CI: 1.8-2.2). A personal history of humerus, hip or vertebral fractures had an adjusted HR of 1.2 (95% CI: 1.1-1.3). Conclusions: The main risk factors for fragility fracture were advanced age, BD result and a personal history of fracture, although 74% of fractures were detected with a bone mineral density classified as normal or osteopenia. Other relevant factors were rheumatoid arthritis or having received prolonged corticosteroid therapy.
