Abstract：
Only previous glucocorticoid use and rheumatoid arthritis were predictors of an early fracture (< 2 years after inclusion). A shorter \'time to first fracture\' was not an independent clinical risk factor for imminent fractures.
Risk factors for fragility fractures independent of BMD were assessed in several prediction models. However, predictors of a shorter \'time to first fracture\' and its impact on imminent fractures are unknown.
We studied the concept of \'time to first fracture\' in the FRISBEE (\"Fracture RIsk Brussels Epidemiological Enquiry\") cohort (3560 postmenopausal women). Validated fractures were divided into 3 groups: first fracture < 2 years, 2-5 years, and > 5 years after inclusion. Factors associated with first fracture risk were evaluated with uni- and multivariate analyses using Cox modeling. We examined \'time to first fracture\' as a risk factor for imminent fractures in untreated subjects and in those receiving pharmacological treatment.
Classical risk factors (age, prior fracture, fall history and low BMD) were associated with first fracture in all groups. Previous glucocorticoids and rheumatoid arthritis (RA) were predictors for fracture < 2 years. Imminent fractures were similar in subjects with or without osteoporosis treatment, despite a higher estimated 10-year risk of fragility fracture in those treated, suggesting that treatment is efficient. \'Time to first fracture\' was not an independent risk factor for imminent fractures.
Among the risk factors considered, previous glucocorticoid use and RA were predictors for early fracture, consistent with the concept of very high risk. The \'time to first validated fracture\' was not an independent risk factor for imminent fractures. Patients with a first osteoporotic fracture should thus be considered at very high risk for re-fracture, independent of the \'time to first fracture\'.
Risk factors for fragility fractures independent of BMD were assessed in several prediction models. However, predictors of a shorter \'time to first fracture\' and its impact on imminent fractures are unknown.
We studied the concept of \'time to first fracture\' in the FRISBEE (\"Fracture RIsk Brussels Epidemiological Enquiry\") cohort (3560 postmenopausal women). Validated fractures were divided into 3 groups: first fracture < 2 years, 2-5 years, and > 5 years after inclusion. Factors associated with first fracture risk were evaluated with uni- and multivariate analyses using Cox modeling. We examined \'time to first fracture\' as a risk factor for imminent fractures in untreated subjects and in those receiving pharmacological treatment.
Classical risk factors (age, prior fracture, fall history and low BMD) were associated with first fracture in all groups. Previous glucocorticoids and rheumatoid arthritis (RA) were predictors for fracture < 2 years. Imminent fractures were similar in subjects with or without osteoporosis treatment, despite a higher estimated 10-year risk of fragility fracture in those treated, suggesting that treatment is efficient. \'Time to first fracture\' was not an independent risk factor for imminent fractures.
Among the risk factors considered, previous glucocorticoid use and RA were predictors for early fracture, consistent with the concept of very high risk. The \'time to first validated fracture\' was not an independent risk factor for imminent fractures. Patients with a first osteoporotic fracture should thus be considered at very high risk for re-fracture, independent of the \'time to first fracture\'.
摘要：
只有以前使用糖皮质激素和类风湿性关节炎是早期骨折的预测因素（纳入后<2年）。较短的首次骨折时间不是即将发生骨折的独立临床危险因素。
目的：在多种预测模型中评估了与BMD无关的脆性骨折的危险因素。然而,首次骨折时间较短的预测因素及其对即将发生的骨折的影响尚不清楚。
方法：我们在FRISBEE（“布鲁塞尔骨折流行病学调查”）队列（3560名绝经后妇女）中研究了“首次骨折时间”的概念。确认骨折分为3组：第1组骨折<2年，2-5年,纳入后>5年。使用Cox建模，通过单因素和多因素分析评估与首次骨折风险相关的因素。我们在未经治疗的受试者和接受药物治疗的受试者中检查了“首次骨折时间”作为即将发生骨折的危险因素。
结果：经典风险因素（年龄，先前的骨折,跌倒史和低BMD）与所有组的首次骨折有关。以前的糖皮质激素和类风湿性关节炎（RA）是骨折<2年的预测因素。在接受或不接受骨质疏松症治疗的受试者中，即将发生的骨折相似，尽管在接受治疗的患者中估计10年脆性骨折的风险较高，表明治疗是有效的。“首次骨折时间”不是即将发生骨折的独立危险因素。
结论：在考虑的危险因素中，既往使用糖皮质激素和RA是早期骨折的预测因子，符合非常高风险的概念。首次确认骨折的时间不是即将发生骨折的独立危险因素。因此，首次骨质疏松性骨折的患者应被认为是再次骨折的高风险。与“第一次骨折的时间”无关。
目的：在多种预测模型中评估了与BMD无关的脆性骨折的危险因素。然而,首次骨折时间较短的预测因素及其对即将发生的骨折的影响尚不清楚。
方法：我们在FRISBEE（“布鲁塞尔骨折流行病学调查”）队列（3560名绝经后妇女）中研究了“首次骨折时间”的概念。确认骨折分为3组：第1组骨折<2年，2-5年,纳入后>5年。使用Cox建模，通过单因素和多因素分析评估与首次骨折风险相关的因素。我们在未经治疗的受试者和接受药物治疗的受试者中检查了“首次骨折时间”作为即将发生骨折的危险因素。
结果：经典风险因素（年龄，先前的骨折,跌倒史和低BMD）与所有组的首次骨折有关。以前的糖皮质激素和类风湿性关节炎（RA）是骨折<2年的预测因素。在接受或不接受骨质疏松症治疗的受试者中，即将发生的骨折相似，尽管在接受治疗的患者中估计10年脆性骨折的风险较高，表明治疗是有效的。“首次骨折时间”不是即将发生骨折的独立危险因素。
结论：在考虑的危险因素中，既往使用糖皮质激素和RA是早期骨折的预测因子，符合非常高风险的概念。首次确认骨折的时间不是即将发生骨折的独立危险因素。因此，首次骨质疏松性骨折的患者应被认为是再次骨折的高风险。与“第一次骨折的时间”无关。
