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.
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.
摘要：
目的：我们的目的是研究骨密度（BMD）测量之间的关联，和脆性骨折，并评估BMD测量和虚弱相结合对骨折风险评估的预测价值。
方法：这项回顾性队列研究分析了在重庆代谢疾病队列研究中来自5,126名农村韩国人的数据。使用Fried的虚弱表型定义虚弱。通过结构化医学访谈评估骨折。调整后的赔率比(OR)是考虑年龄计算的，性别,BMI,行为，BMD,握力,药物,和合并症。
结果：研究队列由5,126名参与者组成，包括1955年(38.1%)男性和3171名(61.9%)女性。骨质疏松显着增加所有类型的骨折风险，除了椎骨骨折，具有调整后的OR(95%置信区间，对于任何骨折，CI)为1.89(1.23-3.47)，2.05（1.37-2.98）用于髋部骨折，2.18（1.06-4.50）其他骨折，财政部为1.71（1.03-3.63）。虚弱的个体表现出两种骨折的风险显着增加（OR2.12，95％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），和财政部（1.87，1.01-3.47）。脆弱和BMD的结合进一步增加了风险，体弱者在BMD类别中表现出升高的OR。在亚组分析中，男性在髋部骨折和MOF中表现出衰弱和骨质疏松之间的显著关联.患有骨质疏松症的虚弱女性表现出所有骨折的最高风险，特别是椎骨（OR5.12，95％CI2.07-9.68）和MOF（OR5.19，95％CI2.07-6.61）。特定年龄的分析显示，与70岁以下的人相比，70岁及以上的人表现出明显更高的骨折风险。虚弱和低BMD的组合进一步增加了骨折风险。在BMD中应用了Failty，并且与单独使用任一评分相比，MOF的风险预测更高（AUC0.825，P=0.000）。
结论：将虚弱与BMD相结合，可以为50岁以上的个体提供更准确的骨折风险评估。
方法：这项回顾性队列研究分析了在重庆代谢疾病队列研究中来自5,126名农村韩国人的数据。使用Fried的虚弱表型定义虚弱。通过结构化医学访谈评估骨折。调整后的赔率比(OR)是考虑年龄计算的，性别,BMI,行为，BMD,握力,药物,和合并症。
结果：研究队列由5,126名参与者组成，包括1955年(38.1%)男性和3171名(61.9%)女性。骨质疏松显着增加所有类型的骨折风险，除了椎骨骨折，具有调整后的OR(95%置信区间，对于任何骨折，CI)为1.89(1.23-3.47)，2.05（1.37-2.98）用于髋部骨折，2.18（1.06-4.50）其他骨折，财政部为1.71（1.03-3.63）。虚弱的个体表现出两种骨折的风险显着增加（OR2.12，95％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），和财政部（1.87，1.01-3.47）。脆弱和BMD的结合进一步增加了风险，体弱者在BMD类别中表现出升高的OR。在亚组分析中，男性在髋部骨折和MOF中表现出衰弱和骨质疏松之间的显著关联.患有骨质疏松症的虚弱女性表现出所有骨折的最高风险，特别是椎骨（OR5.12，95％CI2.07-9.68）和MOF（OR5.19，95％CI2.07-6.61）。特定年龄的分析显示，与70岁以下的人相比，70岁及以上的人表现出明显更高的骨折风险。虚弱和低BMD的组合进一步增加了骨折风险。在BMD中应用了Failty，并且与单独使用任一评分相比，MOF的风险预测更高（AUC0.825，P=0.000）。
结论：将虚弱与BMD相结合，可以为50岁以上的个体提供更准确的骨折风险评估。
