共查询到20条相似文献,搜索用时 15 毫秒
1.
Changes in Hip Fracture Epidemiology: Redistribution Between Ages, Genders and Fracture Types 总被引:4,自引:0,他引:4
After several reports of increasing hip fracture incidence some studies have suggested a trend-break. In a previous study
of hip fractures we forecast a 70% increase in the total number of fractures from 1985 up to year 2000. We therefore studied
the incidence trend for the last 15 years and supply a new prognosis up to year 2010. We recorded all incident hip fractures
treated in the county of ?sterg?tland, Sweden (≈ 400 000 inhabitants) 1982–96. A total of 11 517 hip fractures in men and
women aged 50 years and above were included in the study after cross-validation between a computerized register of radiologic
investigations and the hospital records. The projected number of fractures up to year 2010 was estimated by a Poisson regression
model, considering both age and year of fracture in every single year 1982–96 for the respective fracture type and gender,
and applied to the projected population. The annual number of hip fractures increased by 39% in men and 25% in women during
the study period. Amongst men, the age-adjusted incidence of cervical fractures increased from 188 to 220/100 000 and of trochanteric
fractures from 138 to 170/100 000. In women the incidence of cervical fractures decreased from 462/100 000 to 418/100 000
and of trochanteric fractures from 407/100 000 to 361/100 000. Cervical/trochanteric fracture incidence rate ratio leveled
off, and also the female/male fracture rate ratio declined. A prognosis assuming that the incidence development will continue
as during 1982–96, and a population in agreement with the forecast, predicts that the total age- and sex-adjusted number of
hip fractures will decrease by 11% up to year 2010 compared with 1996. In women and men, however, a decrease of 19% and an
increase of 7% respectively were projected. If the age- and sex-specific incidence remains at the same level as at the end
of the study period, no significant change in the total numbers will occur. A trend-break was thus found in hip fracture incidence
for women but not for men. Whether this is due to therapeutic and/or preventive measures in women is unknown. According to
the most probable scenario a substantial increase in male trochanteric fractures (36%) is expected up to 2010, while all other
hip fractures in both genders will decrease by 4–32% resulting in a total reduction of 11%.
Received: 17 November 2000 / Accepted: 2 July 2001 相似文献
2.
To investigate the relationship between proximal femoral geometry and the occurrence of hip fracture, we compared the geometry
of contralateral normal hips of 120 elderly Chinese women with hip fractures, including 63 femoral neck fractures (group A)
and 57 intertrochanteric fractures (group B) due to minor trauma, with that of 72 normal elderly Chinese women (group C).
The mean ages for group A, B and C subjects were 77.3, 79.7 and 72.9 years, respectively. The femoral neck length (NL), neck
width (NW), diameter of femoral head, femoral shaft width just below the lesser trochanter, and neck–shaft angle (θ) were
measured on the anteroposterior plain pelvic radiographs. The mean ± SD of NL for group A was 50.4 ± 3.3 mm; for group B,
50.6 ± 3.1 mm; and for group C, 48.8 ± 3.6 mm. Statistical analysis by ANOCOVA and regression showed that only NL of women
with hip fractures was significantly longer than controls after correction for age, body height and weight (p <0.01). However, the difference in NL between group A and group B was not significant. By linear regression, the probability
of fracture increased only with older age (p <0.001), longer NL (p <0.005) and lighter body weight (p <0.05). By logistic regression, each standard deviation increase in NL increased the risk of hip fracture (age-adjusted odds
ratio 1.84; 95% CI, 1.11–3.06). The results confirm the relationship between proximal femoral geometry and the occurrence
of hip fracture in elderly Chinese women in Taiwan.
Received: 7 August 1998 / Accepted: 6 January 1999 相似文献
3.
Hip Fracture Incidence Rates in Singapore 1991–1998 总被引:2,自引:0,他引:2
L. K. H. Koh S.-M. Saw J. J. M. Lee K.-H. Leong J. Lee 《Osteoporosis international》2001,12(4):311-318
In this population-based study, we determined the incidence rates of hip fracture among Singapore residents aged 50 years
and above. Information was obtained from a centralized database system which captured admissions with the primary diagnosis
of a closed hip fracture (ICD-9 codes 820, 820.0, 820.2 and 820.8, n= 12 927) from all health care establishments in the country from 1991 to 1998 inclusive. After removing duplicates, hospital
transfers, readmissions and non-acute care admissions, the total number of hip fractures was 9406. Based on the national population
census 1990 (n= 464 100) and yearly population estimates, the age-adjusted hip fracture rates for 1991–1998 (per 100 000) were 152 in men
and 402 in women. This was 1.5 and over 5 times higher than corresponding rates in the 1960s. From 1991 to 1998, these hip
fracture rates tended to increase by 0.7% annually in men and by 1.2% annually in women. Among the three major racial groups,
in men, the Chinese had significantly higher age-adjusted hip fracture rates (per 100 000): 168 (95% confidence interval (CI)
158–178) compared with 128 (95% CI 105–152) for Indians and 71 (95% CI 54–88) for Malays. A similar pattern occurred in women:
410 (95% CI 395–425), for Chinese compared with 361 (95% CI 290–432) for Indians and 264 (95% CI 225–303) for Malays. Since
the 1960s, the main increases in hip fracture rates have been seen in the Chinese and Malays, with the rates in Indians appearing
to decrease. Hip fracture incidence rates in Singapore have risen rapidly over the past 30–40 years, particularly in women,
and are now among the highest in Asia. Significant racial differences in hip fracture rates occur within the same community.
Time trends in hip fracture rates differed between races.
Received: 9 March 2000 / Accepted: 5 September 2000 相似文献
4.
There are limited data describing urban–rural differences in fracture incidence and the overall effect remains controversial.
The aim of this study was to compare symptomatic fracture incidence occurring in geographically defined rural (n= 34 619) and urban (n = 194 974) populations of Southern Tasmania from July 1, 1997 to June 30, 1999. Fractures were ascertained by reviewing reports
from all the radiology providers within the area. In the 2-year study time frame there were 3644 fractures in males and 2657
fractures in females. Fracture incidence was significantly higher in urban compared with rural populations in both sexes (male:
RR 1.60, 95% CI 1.47–1.75; female: RR 1.77, 95% CI 1.58–1.98). This higher urban fracture incidence was present across all
age groups and all fracture types with the exception of knee and pelvis fractures in males (although not all were statistically
significant). In addition, urban men >50 years old had a higher fracture incidence than rural women >50 years old (RR 1.25,
95% CI 1.05–1.50), suggesting that in later life the factors responsible for the urban–rural difference are able to offset
completely the effect of gender. While some of the reduced fracture incidence in the rural population may be explained by
urban drift and underreporting of minor fractures such as foot fractures, the overall pattern of higher fracture risk was
very consistent, suggesting a real difference in whole-of-life symptomatic fracture incidence. Further research at an individual
level is required to determine what factors account for these large urban–rural differences, as they imply a substantial potential
for fracture prevention.
Received: 28 November 2001 / Accepted: 5 April 2001 相似文献
5.
A. V. Schwartz J. L. Kelsey S. Maggi M. Tuttleman S. C. Ho P. V. Jónsson G. Poór J. A. Sisson de Castro L. Xu C. C. Matkin L. M. Nelson S. P. Heyse 《Osteoporosis international》1999,9(3):242-253
A cross-national study of hip fracture incidence was carried out in five geographic areas – Beijing, China; Budapest, Hungary;
Hong Kong; Porto Alegre, Brazil; and Reykjavik, Iceland – during the years 1990–1992. Cases of hip fracture among women and
men of age 20 years and older were identified using hospital discharge data in conjunction with medical records, operating
room logs, and radiology logs. Estimated incidence rates varied widely, with Beijing reporting the lowest rates (age-adjusted
rate per 100 000 population for men 20 years and older = 45.4; women = 39.6) and Reykjavik the highest rates (men = 141.3;
women = 274.1). Rates were higher for women than for men in every area except Beijing. In every area except Budapest, review
of the operating room or radiology logs identified additional cases that were not reported in the discharge list, increasing
the estimated number of hip fractures by 11% to 62%, depending on the area. Review of medical records identified miscoding
of hip fractures (ICD9 820) as ‘shaft of femur and other femur fractures’ (ICD9 821) in the discharge lists of every area
except Budapest, increasing the estimated number of hip fractures by 1% to 30%. The final estimates of hip fracture incidence
taking into account all investigated sources of undercount and overcount ranged from 15% lower to 89% higher than an estimate
based on the discharge diagnoses alone. Although these results indicate substantial limitations in relying on hospital discharge
data alone to estimate hip fracture incidence rates, the extent of errors found in the discharge lists is smaller than the
large international variation found here and previously reported in incidence rates. The findings support the conclusion that
the differences reported among countries mainly reflect genuine variation in the hip fracture incidence rates.
Received: 23 January 1998 / Accepted: 22 June 1998 相似文献
6.
E. Guilley T. Chevalley F. Herrmann D. Baccino P. Hoffmeyer C.-H. Rapin R. Rizzoli 《Osteoporosis international》2008,19(12):1741-1747
Summary In this prospective 10-year study in elderly aged 60 years and over, there was a 1.3% per year reduction in the standardized
incidence of hip fracture in women but not in men. This decrease was mainly due to changes in the standardized incidence of
hip fracture in institution-dwelling women.
Introduction A decrease in age-adjusted hip fracture incidence has been recently demonstrated in some countries. Since a large proportion
of hip fractures occur in nursing homes, we analyzed whether this decreasing trend would be more detectable in institution-dwelling
elderly compared with community-dwelling elderly.
Methods All hip fracture patients aged 60 years and over were identified in a well-defined area. Incidence of hip fracture, age- and
sex-adjusted to the 2000 Geneva population, was computed in community- and institution-dwelling elderly.
Results From 1991 to 2000, 1,624 (41%) hip fractures were recorded in institutionalized-dwelling elderly and 2,327 (59%) in community-dwelling
elderly. The standardized fracture incidence decreased by 1.3% per year in women (p = 0.039), but remained unchanged in men (+0.5%; p = 0.686). Among institution-dwelling women, hip fracture incidence fell by 1.9% per year (p = 0.044), whereas it remained stable among community-dwelling women (+0.0%, p = 0.978). In men, no significant change in hip fracture incidence occurred among institution- or community-dwelling elderly.
Conclusions The decrease in the standardized hip fracture incidence in institution-dwelling women is responsible for the reversal in secular
trend. Future research should include stratification according to the residential status to better identify the causes responsible
for the trend in hip fracture incidence.
Edith Guilley and Thierry Chevalley contributed equally to this study 相似文献
7.
Symptomatic fractures are a significant problem in terms of both morbidity and financial cost. Marked variation in both total
and site-specific fracture incidence has been documented internationally but there is limited within-country data. This prospective
population-based study documented the incidence of all symptomatic fractures occurring from July 1, 1997 to June 30, 1999
in adults ≥50 years of age resident in Southern Tasmania (total population ≥50 years: 64 688). Fractures were ascertained
by reviewing reports from all the radiology providers within the area. There were 701 fractures in men and 1309 fractures
in women. The corresponding fracture incidence in men and women was 1248 and 1916 per 100 000 person-years, respectively.
Residual lifetime fracture risk in a person aged 50 years was 27% for men and 44% for women with fractures other than hip
fractures constituting the majority of symptomatic fracture events. These fracture risk estimates remained remarkably constant
with increasing age. In comparison to Geelong, there were significantly lower hip fracture rates (males: RR 0.59, 95% CI 0.45–0.76;
females: RR 0.61, 95% CI 0.53–0.71) but significantly higher distal forearm fractures (males: RR 1.87, 95% CI 1.10–3.78; females:
RR 1.31, 95% CI 1.11–1.55) and total fractures in men (RR 1.31, 95% CI 1.17–1.46) but not women (RR 1.05, 95% CI 0.98–1.13).
In contrast, Southern Tasmania had lower age-standardized rates of all fractures compared with Dubbo (RR 0.28–0.79). In conclusion,
this study provides compelling evidence that fracture incidence varies between different geographic sites within the same
country, which has important implications for health planning. In addition, the combination of high residual fracture risk
and short life expectancy in elderly subjects suggests fracture prevention will be most cost-effective in later life.
Received: 27 April 2000 / Accepted: 16 August 2000 相似文献
8.
Maternal Height, Childhood Growth and Risk of Hip Fracture in Later Life: A Longitudinal Study 总被引:2,自引:0,他引:2
C. Cooper J. G. Eriksson T. Forsén C. Osmond J. Tuomilehto D. J. P. Barker 《Osteoporosis international》2001,12(8):623-629
Although measures to enhance bone mineralization during childhood and adolescence are widely incorporated into preventive
programmes against osteoporotic fracture, there are no published data directly linking growth rates in childhood with the
risk of later hip fracture. We addressed this issue in a unique Finnish cohort in whom birth and childhood growth data were
linked to later hospital discharge records. This permitted follow-up of 3639 men and 3447 women who were born in Helsinki
University Central Hospital between 1924 and 1933, who went to school in Helsinki and still lived in Finland in 1971. Body
size at birth was recorded and an average of 10 measurements were obtained of height and weight throughout childhood. We identified
112 subjects (55 men and 57 women) who sustained a hip fracture during 165 404 person-years of follow-up. After adjustment
for age and sex in a proportional hazards model, we identified two major determinants of hip fracture risk: tall maternal
height (p<0.001) and a low rate of childhood growth (height, p= 0.006; weight, p = 0.01). The hazard ratio for hip fracture was 2.1 (95% CI 1.2–3.5) among men and women born to mothers taller than 1.61
m, when compared with those whose mothers were shorter than 1.54 m. The ratio was 1.9 (95% CI 1.1–3.2) among those whose rate
of childhood height gain was below the lowest quartile for the cohort, compared with those whose growth rate was above the
highest quartile. The effects of maternal height and childhood growth rate were statistically independent of each other, and
remained after adjusting for socioeconomic status. The patterns of childhood growth that predicted future hip fracture differed
between boys and girls. In boys, there was a constant deficit in height and weight between ages 7 and 15 years among those
later sustaining fractures; in girls, there was a progressively increasing deficit in weight but a delayed height gain among
those later sustaining fractures. This epidemiologic study provides the first direct evidence that a low rate of childhood
growth is a risk factor for later hip fracture. Whether reduced growth rate is a consequence of childhood lifestyle, genetic
background or intrauterine hormonal programming, the data support measures to optimize childhood growth as part of preventive
strategies against osteoporotic fracture in future generations.
Received: May 2000 / Accepted: June 2001 相似文献
9.
A retrospective chart review was carried out on all consecutive patients over 65 years of age admitted to a tertiary care
teaching hospital with a diagnosis of a new hip fracture. A further chart review occurred after discharge from post-surgery
rehabilitation. The primary objective was to evaluate the prevalence of osteoporosis diagnosis and treatment in both phases
of the study. Secondary objectives included evaluation of the mortality rates, length of stay, prevalence of osteoporosis
investigation, and prevalence of osteoporosis diagnosis based on the clinical subspecialty involved. There were 311 patients
evaluated in the initial phase, and 226 after rehabilitation. The mortality rate was 5.8% (10% for men, 4% for women; p<0.005) in the acute care hospital and 9.3% (8% men, 10% women) during rehabilitation. Previous hip fracture occurred in 17.4%,
and 1.5% were readmitted during the study period with fracture of the opposite hip. Osteoporosis was diagnosed in the acute
care hospital on admission in 11.9% and on discharge in 15.4%. In the rehabilitation hospital it was diagnosed in 9.7% on
admission and 11.2% on discharge (p = NS). Osteoporosis treatment (including calcium or vitamin D therapy) was instituted in 13% on admission to acute care and
in 9.7% at the time of discharge. For the rehabilitation hospital, treatment occurred in 12.8% on admission and 10.2% on discharge.
The diagnosis of osteoporosis significantly increased the prevalence of treatment (p<0.001). Use of specific agents (hormone replacement therapy, bisphosphonates or calcitonin) occurred in <6% of all patients.
Osteoporosis is under-diagnosed and under-treated in this group of elderly hip fracture patients. It is associated with significant
mortality and morbidity and every effort should be made to prevent future fractures. Physicians in the “front line” of hip
fracture treatment are missing this key aspect of management in their patients. Education of these physicians, as well as
the public, may be the key to addressing this care gap.
Received: 12 March 2001 / Accepted: 23 July 2001 相似文献
10.
Incidence of Distal Forearm Fracture in British Men and Women 总被引:1,自引:0,他引:1
T. W. O’Neill C. Cooper J. D. Finn M. Lunt D. Purdie D. M. Reid R. Rowe A. D. Woolf W. A. Wallace 《Osteoporosis international》2001,12(7):555-558
Fracture of the distal forearm is one of the most frequent osteoporotic fractures. However, there are few data concerning
its incidence in Britain. The aim of this study was to determine the incidence of distal forearm fracture in adult British
men and women. Six centers took part in the study: Aberdeen, Hull, Nottingham, Portsmouth, Southampton and Truro. At each
center, men and women aged 35 years and over with an incident distal forearm fracture and who resided in the catchment area
of the main hospital at that center, were identified during a 12 month period. Incident fractures were identified from all
possible point-of-contact sources in each locality, including accident and emergency records, fracture clinics, ward listings
and plaster room registers. The population at risk was defined geographically according to postcode and the denominator obtained
from 1991 census data mapped to these postcodes. During the 12 month study period, 3161 individuals with distal forearm fracture
were identified. The age-adjusted incidence, age 35 years and over, was 36.8/10 000 person-years in women and 9.0/10 000 person-years
in men. In women, the incidence of fracture increased progressively with age from the perimenopausal period, while in men
the incidence remained low until later life. Fractures were more frequently left-sided (55.6%) and 19.4% of subjects required
hospitalization. On the basis of these data we estimate that 71 000 adult men and women sustain a distal forearm fracture
in Britain each year. Compared with previous British surveys the pattern of incidence with age appears to have changed in
women, the reason for this is unclear.
Received: August 2000 / Accepted: January 2001 相似文献
11.
Long-Term Trends in the Incidence of Distal Forearm Fractures 总被引:1,自引:1,他引:0
L. J. Melton III P. C. Amadio C. S. Crowson W. M. O'Fallon 《Osteoporosis international》1998,8(4):341-348
12.
The Incidence of Hip Fracture in Four Asian Countries: The Asian Osteoporosis Study (AOS) 总被引:13,自引:0,他引:13
E. M. C. Lau J. K. Lee P. Suriwongpaisal S. M. Saw S. Das De A. Khir P. Sambrook 《Osteoporosis international》2001,12(3):239-243
The Asian Osteoporosis Study (AOS) is the first multicenter study to document and compare the incidence of hip fracture in
four Asian countries. Hospital discharge data for the year 1997 were obtained for the Hong Kong SAR, Singapore, Malaysia and
Thailand (Chiang Mai). The number of patients who were 50 years of age and older and who were discharged with a diagnosis
of hip fracture (ICD9 820) was enumerated. The age-specific incidence rates were deduced and were directly adjusted to the
US white population in 1989. The age-adjusted rates for men and women (per 100 000) are as follows: Hong Kong, 180 and 459;
Singapore, 164 and 442; Malaysia, 88 and 218; Thailand, 114 and 289; compared with US White rates of 187 in men and 535 in
women, published in 1989. We conclude that there is moderate variation in the incidence of hip fracture among Asian countries.
The rates were highest in urbanized countries. With rapid economic development in Asia, hip fracture will prove to be a major
public health challenge.
Received: 14 March 2000 / Accepted: 17 October 2000 相似文献
13.
T. P. van Staa T. P. van Staa T. P. van Staa H. G. M. Leufkens C. Cooper 《Osteoporosis international》2002,13(8):624-629
The extent to which a fracture at one skeletal site predicts further fractures at other sites remains uncertain. We addressed
this issue using information from the UK General Practice Research Database, which contains the medical records of general
practitioners; our study population consisted of all patients aged 20 years or older with an incident fracture during 1988
to 1998. We identified 222 369 subjects (119 317 women, 103 052 men) who had sustained at least one fracture during follow-up.
There was a 2- to 3-fold increase in the risk of subsequent fractures at different skeletal sites. A patient with a radius/ulna
fracture had a standardized incidence ratio (SIR) of 3.0 (95% confidence interval 2.9–3.1) for fractures at a different skeletal
site; for initial vertebral fracture, this ratio was 2.9 (2.8–3.1) and for initial femur/hip fracture it was 2.6 (2.5–2.7).
The SIRs were generally higher among men than women. Men aged 65–74 years with a radius/ulna fracture or vertebral fracture
had substantially higher rates of subsequent femur/hip fractures than expected; SIRs were 6.0 (3.4–9.9) and 13.4 (7.3–22.5).
Corresponding SIRs among women of similar age were 3.3 (2.8–3.9) and 5.8 (4.1–8.1), respectively. Men and women aged 65 years
or older with a vertebral fracture had a 5-year risk of femur/hip fracture of 6.7% and 13.3%, respectively. Our results indicate
that fractures at any site are strong risk factors for subsequent fractures, among both elderly men and women.
Received: 19 November 2001 / Accepted: 13 February 2002 相似文献
14.
K. M. Sanders E. Seeman A. M. Ugoni J. A. Pasco T. J. Martin B. Skoric G. C. Nicholson M. A. Kotowicz 《Osteoporosis international》1999,10(3):240-247
There is little population-based data concerning fracture rates in Australia. We ascertained all fractures occurring during
2 years in adults aged 35 years and over residing within a defined region (population 218 000), representative of the Australian
population. The major strength of this study is the comprehensive ascertainment of fractures, which was ensured by regular
searches of the only two radiologic providers in the Geelong Osteoporosis Study region. Nevertheless, vertebral fractures
are likely to be underestimated since our ascertainment relied on a clinical indication for a medical imaging procedure. Among
those aged 35 – 55 years, the fracture rate (persons per 10 000/year) in men was about double the rate in women (65 vs 35).
The fracture rate was almost 7 times higher in women over 60 years versus women less than 55 years of age. In contrast, the
fracture rate in men over 60 years was only 50% higher than in men less than 55 years of age (72 vs 104). Fracture rates in
women and men were highest at the hip (28 and 10 respectively), spine (21 and 7), distal forearm (Colles’) (18 and 4) and
humerus (11 and 3), and were 3–4 times higher in women than men. These fractures accounted for 63% of all fractures in women
and 32% in men. By contrast, the rate of lower leg and ankle fractures was less than 10 per 10 000 in both women and men and
did not increase to the same extent with age. Hip fracture rates appear high, particularly among the older age strata, compared
with retrospective ascertainment in other populations. In Australia, as in many other countries, there is an increasing longevity
of the population. The number of women aged 90 years and over increased by 32% and the number of men of this age increased
by 48% in the 5 years between the Australian national census of 1991 and 1996. Given stable fracture rates, the substantial
health burden imposed by age-related fractures, particularly hip fractures, will continue to escalate in both women and men.
Received: 6 October 1998 / Accepted: 16 February 1999 相似文献
15.
P. Kannus M. Palvanen S. Niemi J. Parkkari M. Järvinen 《Osteoporosis international》2000,11(5):443-448
The purpose of our epidemiologic study was to determine the current trend in the number and incidence of osteoporotic pelvic
fractures in Finland, a country with a Caucasian population of 5 million. Thus, all Finns 60 years of age or older who were
admitted to hospitals in 1970–1997 for primary treatment of a first osteoporotic pelvic fracture were selected from The National
Hospital Discharge Register. In each year of the study, the number and the age-specific and age-adjusted incidences of fractures
were expressed as the number of patients per 100 000 individuals. The total number of osteoporotic pelvic fractures increased
considerably in Finland during the study period, from 128 in 1970 to 913 in 1997, an average increase of 23% a year. The corresponding
fracture incidence (per 100 000 persons 60 years of age or older) was 20 in 1970 and 92 in 1997. The mean age of the patients
also increased, from 74 years (1970) to 80 years (1997). Despite this, the age-adjusted incidence of osteoporotic pelvic fractures
also showed a steady increase from 1970 to 1997: in women, from 31 to 103, and in men, from 13 to 38 (relative increases were
232% and 192%, respectively). If this trend continues, the current number of osteoporotic pelvic fractures in this country
(about 900 fractures per year) may treble by the year 2030 (about 2700 fractures per year). We conclude that the number of
osteoporotic pelvic fractures in elderly Finns is increasing at a rate that cannot be explained simply by demographic changes
and therefore effective preventive measures should be urgently initiated to control the increasing burden of these age-related
fractures.
Received: 5 July 1999 / Accepted: 9 November 1999 相似文献
16.
A. N. A. Tosteson S. E. Gabriel M. R. Grove M. M. Moncur T. S. Kneeland L. J. Melton III 《Osteoporosis international》2001,12(12):1042-1049
The objective of the study was to estimate the impact of hip and vertebral fractures on quality of life in postmenopausal
women using a preference-based health measure that is appropriate for economic evaluations and to investigate correlates of
health outcome. Interviews to assess health-related quality of life, which also documented other health conditions and characteristics,
were undertaken in women age 50 years and older without osteoporotic fractures compared with women with hip and/or vertebral
fracture(s). Health status was characterized by self-reported physical limitations and the mental and physical component summary
scores of the SF-36. Quality-adjusted life years (QALYs), which reflect each individual’s assessment of her overall health
utility, were estimated with time tradeoff values. Regression methods were used to examine QALY correlates (e.g. time since
fracture) for each fracture group and to estimate differences in QALYs between fracture and non-fracture subjects after accounting
for other patient characteristics. Among 382 women ages 50–96 years, fracture subjects were significantly older, less likely
to use hormone replacement therapy and more likely to report physical limitations than non-fracture subjects. On the QALY
scale, where 1 represents perfect health and 0 represents death, mean QALY values were 0.82 (95% CI: 0.76, 0.87) among 114
women with one or more vertebral fractures and 0.63 (95% CI: 0.52, 0.74) among 67 with hip fracture compared with 0.91 (95%
CI: 0.88, 0.94) among 201 women without fracture. No significant correlates of QALYs were identified among women with vertebral
fracture alone. Among hip fracture subjects, time since hip fracture and presence of a vertebral fracture were significant
correlates of QALYs. In multiple regression analyses, estimated QALY differences (fracture minus non-fracture subjects) ranged
from –0.05 to –0.55 and were equivalent to losses of 20–58 days, 23–65 days and 115–202 days per year for vertebral fracture
(p= 0.001), hip fracture (p= 0.009) and hip plus vertebral fracture (p<0.001) subjects, respectively, depending on age. Thus to adequately assess the cost-effectiveness of osteoporosis treatment,
the negative impact of vertebral fractures on QALYs, even among women who have survived a hip fracture, must be considered.
Received: 2 February 2001 / Accepted: 23 July 2001 相似文献
17.
Recent Decline in Heavy Outdoor Work Activity Predicts Occurrence of Fractures among the Home-Dwelling Elderly 总被引:1,自引:0,他引:1
M. Herala S.-L. Kivelä R. Honkanen K. Koski P. Laippala H. Luukinen 《Osteoporosis international》2002,13(1):42-47
The contribution of reduced physical activity of a defined duration to the risk of fall-related fractures and serious soft
tissue injuries is not known. We conducted a prospective population-based study among the home-dwelling elderly to examine
the association between a recent decline in physical activity and the occurrence of fall-related fractures and soft tissue
injuries. The study population consisted of representative sample of home-dwelling older adults who conducted heavy outdoor
work activity at least once a week at baseline (n= 284; 136 men, 148 women) and among whom in 93 persons (33%) heavy outdoor work activity was found to have declined during
the 21/2 years follow-up. Fall-related fractures (n= 24) and serious soft tissue injuries (n= 49) were recorded from the time of the follow-up examination until the end of a further follow-up period lasting 31/2 years
on average. A decline in heavy outdoor work activity did not predict the occurrence of soft tissue injuries (Mantel–Cox 0.795,
p = 0.373), but a greater proportion of those with a decline (n= 14, 15%) than of others (n= 10, 5%) suffered fractures (Mantel–Cox 10.231, p= 0.001). Other risk factors for fractures were female sex (p= 0.03), slow choice reaction time (p= 0.02) and dependency as regards at least one basic activity of daily living (p= 0.01). According to the Cox proportional hazard model, the adjusted hazard ratio of fracture as regards a decline in heavy
outdoor work activity was 2.7 (95% CI 1.14–6.62). A recent decline in heavy outdoor work activity predicts the occurrence
of fractures, but not the occurrence of serious soft tissue injuries. Early recognition of a decline in physical activity
may help in prevention of fractures among the elderly.
Received: 18 March 2001 / Accepted: 3 August 2001 相似文献
18.
Osteoporosis is a disease that culminates in fragility fractures and, therefore, imposes major burden on the health economy.
In dealing with this worldwide condition, it is prudent to use a reliable, inexpensive, portable diagnostic means that does
not use ionizing radiation and is capable of measuring bone properties at several sites. Recently, a quantitative ultrasound
device (Omnisense) that measures speed of sound (SOS) at multiple skeletal sites was introduced. The Omnisense combines the
“axial transmission” mode and the critical angle concept. Preliminary reports suggested that of the different skeletal sites
measured by this device, the distal third of the radius is the preferred measurement site for osteoporosis. In this cross-sectional
study, SOS was determined at the radius using Omnisense in 50 hip-fractured elderly women (group F, age 76.1 ± 6.0 years),
130 elderly controls (group NF, age 71.5 ± 5.2 years) and 185 young healthy controls (group YH, age 40.6 ± 3.0 years). Actual
SOS was significantly lower in group F compared with group NF (p = 0.0001). Whereas SOS T-scores calculated for each woman and stratified into age subgroups within each of the study groups indicate decline from
–2.22 to –3.56 in group F and from –1.56 to –3.17 in group NF, there was an increase from –0.02 to 0.03 in group YH. Age-
and BMI-adjusted logistic regression for hip fracture discrimination indicated an area under the receiver operating characteristic
curve for hip fracture of 0.79 (95% CI, 0.73–0.86; p = 0.005) and an odds ratio of 1.92 (95% CI, 1.22–3.02; p = 0.005). We conclude that SOS measured at the radius by Omnisense discriminates subjects with hip fracture from controls.
Prospective studies are needed to support the role of Omnisense in assessing the risk of hip fracture.
Received: 16 March 1999Accepted: 29 October 1999 相似文献
19.
Although widely regarded as a disease of women, osteoporosis does cause considerable morbidity and mortality in men. The
lifetime risk of an osteoporortic fracture for a man is 1 in 12 and 30% of all hip fractures occur in men. In women, low-trauma
distal forearm fracture is widely regarded as a typical early manifestation of postmenopausal osteoporosis. Traditionally,
this has not been thought to be the case for men. We present a case–control study of 147 men with distal forearm fracture
compared with 198 age-matched controls. The controls were selected from a pre-existing database of dual-energy X-ray absorptiometry
scans of healthy volunteers. Both groups were sent questionnaires regarding basic demographics, fracture history and risk
factors for osteoporosis, and the fracture group was asked to attend for bone densitometry. There were 103 responses from
the fracture group (70%), of whom 67 (47%) underwent densitometry. There were 165 (83%) responses from the control group.
Secondary causes of osteoporosis could be identified in 51% of the fracture group and 37% of the control group. The fracture
group had significantly lower bone mineral density at all sites measured compared with the controls (0.75 g/cm2 vs 0.85 g/cm2 at the femoral neck, p<0.0001; 0.95 g/cm2 vs 1.03 g/cm2 at the total femur, p= 0.001; and 0.99 g/cm2 vs 1.06 g/cm2 at the lumbar spine, p= 0.001). These differences remained after adjusting for age and body mass index (p<0.0005 at all sites). Overall, 41.8% of the fracture group were osteoporotic in at least one site (T-score <−2.5 SD below the mean for young men) compared with only 10.3% of controls. This study is the first to demonstrate
that men with distal forearm fractures have lower bone mineral density than their peers and a higher risk of osteoporosis.
Received: 28 November 2001 / Accepted: 19 February 2002 相似文献
20.
J. M. Le Parc P. Plantin G. Jondeau M. Goldschild M. Albert C. Boileau 《Osteoporosis international》1999,10(6):475-479
Sixty adult patients (40 women, 20 men) with Marfan syndrome (MFS) according to the Berlin criteria had a full clinical examination
and bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry of the hip and nondominant forearm. BMD was
expressed as a Z-score and compared with the reference population of the Hologic database. In MFS men, BMD (g/cm2) was compared with the BMD of 45 normal tall Caucasian adults. Osteocalcin was measured by radioimmunoassay. In patients
with MFS, BMD was compared between patients with and without previous fractures and according to the phenotypic severity of
MFS. The mean age of the patients was 32.9 ± 9.3 years (women 32.5 ± 9.7, men 33.4 ± 8.6), mean height was 180.3 ± 10.3 cm
(women 176.3 ± 9.2, men 188.1 ± 7.5) and mean body mass index 20.9 ± 3.6 kg/m2 (women 20.8 ± 3.4, men 20.95 ± 3.97). Hyperlaxity score (Beighton criteria) was 6.9 ± 1.1. Six patients (10%) had a previous
fracture. Thirty per cent of patients had had at least one previous operation for scoliosis, aortic dilatation or eye problems.
BMD values in the 60 patients were as follows: Z-score of the hip, −1.26 ± 0.93, p<10−9 (neck, −0.93 ± 1.09, p<10−9; trochanter, −1.31 ± 0.85, p<10−9; intertrochanter, −1.39 ± 0.99, p<10−9; Ward’s triangle, −0.93 ± 1.88, p<10−9); Z-score of the radius: −1.6 ± 1.06, p<10−9 (1/3 proximal, −1.29 ± 1.03; mid-radius, −1.94 ± 1.04; ultradistal, −0.68 ± 1.1, p<10−9). The decrease in BMD was similar in men and women at both the hip and the radius. BMD in MFS patients was significantly
decreased at cortical compared with trabecular sites (radius 1/3 proximal vs ultradistal, p<0.0001; total femur vs Ward’s triangle, p<0.0005). No difference in BMD was found between MFS patients with or without previous fractures and those with severe or
less severe phenotypic expression of MFS. An influence of height and weight in MFS on BMD is suspected. Osteocalcin was not
increased in our group of MFS patients. Thus both men and women with MFS have a significant deficit of BMD at the hip and
radius. The decrease in BMD is present equally in both sexes and is more pronounced at predominantly cortical sites. In our
group of patients we found no increase in fractures and no relation between decreased BMD and phenotypic expression of the
syndrome.
Received: 30 October 1998 / Accepted: 26 May 1999 相似文献