合并症在骨折患者中很常见，但骨折与合并症之间的相互作用仍不清楚。本研究旨在定义老年人中特定的多发病群，并量化多发病群与骨折风险之间的关联。这项全国性队列研究包括丹麦 170 万名年龄≥50 岁的成年人，他们在 2001 年至 2014 年期间因一次低创伤事件进行了随访断裂。慢性病和骨折是通过丹麦国家医院出院登记册确定的。分别进行潜在类别分析和 Cox 回归来定义聚类并量化骨折风险。该研究包括 793 815 名男性（年龄：64±10）和 873 524 名女性（65.5±11），其中三分之一患有 ≥1 种慢性疾病。先前存在的慢性疾病将个体分为低多重发病率（男性 80.3%，女性 83.6%）、心血管疾病（12.5%、10.6%）、恶性疾病（4.1%、3.8%）、糖尿病（2.4%、2.0%）和肝簇（0.7%，仅限男性）。这些簇将患有晚期、复杂或晚期疾病的个体与患有早期疾病的个体区分开来。在中位随访 14 年（IQR：6.5, 14）期间，有 95 372 名男性和 212 498 名女性发生了意外骨折。多种疾病的存在与骨折风险显着增加相关，与年龄和性别无关。重要的是，多发病集群在评估骨折风险方面具有最高的判别性能，而它们与骨折风险的关联强度等于或超过每个集群中最流行的个体慢性疾病和基于计数的合并症指数。 未来的骨折预防策略应考虑合并症。与单一疾病或基于计数的合并症指数相比，多重发病集群可以更深入地了解骨折风险。© 作者 2024。由牛津大学出版社代表英国老年病学会出版。版权所有。如需权限，请发送电子邮件至：journals.permissions@oup.com。

Comorbidities are common in fracture patients, but the interaction between fracture and comorbidities remains unclear. This study aimed to define specific multimorbidity clusters in older adults and quantify the association between the multimorbidity clusters and fracture risk.This nationwide cohort study includes 1.7 million adults in Denmark aged ≥50 years who were followed from 2001 through 2014 for an incident low-trauma fracture. Chronic diseases and fractures were identified from the Danish National Hospital Discharge Register. Latent class analysis and Cox's regression were conducted to define the clusters and quantify fracture risk, respectively.The study included 793 815 men (age: 64 ± 10) and 873 524 women (65.5 ± 11), with a third having ≥1 chronic disease. The pre-existent chronic diseases grouped individuals into low-multimorbidity (80.3% in men, 83.6% in women), cardiovascular (12.5%, 10.6%), malignant (4.1%, 3.8%), diabetic (2.4%, 2.0%) and hepatic clusters (0.7%, men only). These clusters distinguished individuals with advanced, complex, or late-stage disease from those having earlier-stage disease. During a median follow-up of 14 years (IQR: 6.5, 14), 95 372 men and 212 498 women sustained an incident fracture. The presence of multimorbidity was associated with a significantly greater risk of fracture, independent of age and sex. Importantly, the multimorbidity clusters had the highest discriminative performance in assessing fracture risk, whereas the strength of their association with fracture risk equalled or exceeded that of both the individual chronic diseases most prevalent in each cluster and of counts-based comorbidity indices.Future fracture prevention strategies should take comorbidities into account. Multimorbidity clusters may provide greater insight into fracture risk than individual diseases or counts-based comorbidity indices.© The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.