Bone mineral density in chinese elderly women with hip fracture

In order to examine the status of osteoporosis of the patients with hip fracture, we assessed the bone mineral density (BMD) of the contralateral hip of 81 elderly females with hip fracture and compared those with 77 normal Chinese women. The age of fracture subjects was 73.5±6.6 years (mean±SD), and 69.2±6.9 years for the controls. All of these fractures were caused by minor trauma, such as falls from a standing position or slipping to the ground. The Norland 2600 dual-photon absorptiometer (DPA) was used to evaluated the BMD in the femoral neck, trochanter, and Ward's triangle areas. The BMD for the fracture subjects was significantly lower than those of the controls. By linear regression, the probability of fracture increased exponentially with age and low BMD. The mean BMD for femoral neck of the fracture subjects versus controls was 0.556 versus 0.624 g/cm²; for trochanter: 0.505 versus 0.566 g/cm²; for Ward's triangle: 0.432 versus 0.485 g/cm². Both negative predictive value (NPV) and positive predictive value (PPV) were acceptable at the prevalence of hip fracture of 5% or 20% and at a cutoff point of 0.65 g/cm². These data revealed that the degree of relative osteoporosis in the patients with hip fractures was more severe than that of controls.     

老年女性髋部骨折与DXA骨强度参数的相关性研究

目的探讨髋部骨强度参数对老年女性髋部骨折的影响。方法对2014年10月-2017年2月至南京市中医院骨伤科就诊体检、年龄大于60岁的受试者进行双能X线测定,并收集受试者髋部骨折病史等临床资料进行回顾性分析。共纳入93名受试者,按骨折史分为髋部骨折组33人,胸腰椎骨折组32人,正常组28人,对骨密度、髋部几何参数及髋部力学参数进行统计学分析。结果股骨颈BMD(g/cm~2)、全髋BMD(g/cm2)、股骨颈皮质比率(%)、股骨颈最小宽度(mm)、d3(mm)、y(mm)等参数与老年女性髋部骨折具有显著相关性。结论本项研究基于双能X线测定法,发现部分髋部几何力学参数与老年女性髋部骨折相关,具有重要的临床指导意义,同时改变了单一的"低骨量—高骨折风险"预测模式,形成"骨密度+髋部几何力学分析"多元化模式,可有效提高老年女性髋部骨折风险的预测能力。     

Structural determinants of hip fracture in elderly women: re-analysis of the data from the EPIDOS study

Hip fracture is the most disastrous osteoporotic fracture, characterized by high mortality, morbidity and institutionalization for the patient and by high economic costs for the health care system. The morphology of the upper part of the femur can influence the risk of hip fracture, e.g., a longer femoral neck is associated with a higher risk of cervical fractures, but not trochanteric ones. In this study, we evaluated the prediction of hip fracture risk by morphological parameters estimated from DXA measurements, and we compared their predictive value for cervical and trochanteric fractures in elderly women by reanalyzing previously published data (Duboeuf et al. J Bone Miner Res 1997 12 1895). This nested case-control study was performed in 232 elderly community-dwelling women from the EPIDOS cohort, including 65 women who sustained a hip fracture. After adjustment for confounding variables, women who sustained a cervical fracture had lower areal bone mineral density (aBMD), lower cortical thickness and a higher average buckling ratio ( P <0.005 for all) as well as longer femoral neck ( P <0.01) than controls. Women who sustained a trochanteric fracture had lower aBMD, lower cortical thickness and higher buckling ratio than controls ( P <0.0001) and than women who sustained a cervical fracture ( P <0.05). Their bending resistance (cross-sectional moment of inertia—CSMI, section modulus) was significantly lower in comparison with controls ( P <0.05–0.001). A decrease in aBMD, cortical thickness, CSMI and section modulus as well as an increase in buckling ratio were predictive of all hip fractures (OR –1.42–2.46 per 1 SD, P <0.05–0.0001), but the ORs for all structural parameters were markedly higher for trochanteric than for cervical fractures. CSMI and section modulus were predictive of trochanteric, but not cervical fractures. However, aBMD was strongly correlated with the CSA, cortical thickness and buckling ratio ( r ²>0.74), which suggests that they convey the same information. CSMI and section modulus correlated with aBMD more weakly, but their OR lost statistical significance after adjustment for aBMD. In conclusion, low femoral neck aBMD, CSA and cortical thickness as well as a high buckling ratio are associated with the higher risk of hip fracture, especially trochanteric ones. These indices are highly correlated with aBMD and convey the same message. The calculated CSMI and section modulus predict trochanteric fractures, but not cervical fractures, and their statistical significance is lost after adjustment for aBMD, indicating that they reflect mainly aBMD, not mechanical properties. Thus, the independent contribution of the external diameter of the femoral neck to the risk of hip fracture cannot be reliably estimated by this technique.     

The effects of homocysteine and MTHFR genotype on hip bone loss and fracture risk in elderly women

Summary  Few studies have evaluated the effects of homocysteine and methylenetetrahydrofolate reductase (MTHFR) genotype on age-related bone loss. In our 5-year cohort study with 1,213 women aged 70–85 years, high homocysteine is associated with greater hip bone loss but not fracture risk. The effect of MTHFR genotype on bone density and fracture is weak. Introduction  Previous studies on the effects of homocysteine and MTHFR genotype on bone mineral density (BMD) and osteoporotic fracture risk have shown inconsistent results. Few studies have evaluated their effects on age-related bone loss. We evaluated the effects of homocysteine and MTHFR genotype variation on hip BMD and fracture risk over 5 years in a cohort of 1,213 community-dwelling women aged 70–85 years. Methods  Nutritional intake and prevalent fracture status were assessed at baseline, plasma homocysteine was measured at year 1, and hip dual-energy X-ray absorptiometry (DXA) BMD was measured at years 1 and 5. Clinical incident osteoporotic fractures confirmed by radiographic report were collected throughout the study and the MTHFR gene C677T and A1298C polymorphisms genotyped. Data were analyzed using analysis of covariance and Cox proportional hazard regression. Results  The highest tertile of homocysteine was associated with a greater hip BMD loss over 4 years (−2.8%) compared to the middle (−1.6%) and lowest tertiles (−1.2%) (P < 0.001). This effect remained after adjustment for covariates. There was no effect of homocysteine on fracture prevalence or incidence. MTHFR gene variation was only weakly related to one of the bone outcome measures. Conclusion  In this study population, high homocysteine is associated with greater hip bone loss but not fracture risk.     

Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study

The aim of this prospective study was to document the functional outcome and quality of life (QoL) over 1 year following hip fracture in elderly women. A total of 159 unselected elderly women with a first hip fracture were matched for age and residence with an equal number of control women. Functional status was measured by completing a Rapid Disability Rating Scale version 2 (RDRS-2) questionnaire [score ranging from 0 (best) to 54 (worse)], before hospital discharge and 12 months later. To examine longitudinal change in health-related QoL, fracture subjects and controls completed the Short Form 36 (SF-36) questionnaire. For the 134 women still alive at 1 year, the mean RDRS-2 score before hospital discharge was 16.2 (95% CI: 15.0–18.0) and 3.5 (2.6–4.3) in patients and controls, respectively (P<0.001). During the year following hospital discharge, the mean RDRS-2 score improved to 13.0 (11.1–14.1) in hip-fracture women and worsened to 4.3 (3.3–5.0) in the control group (differences with initial scores: P<0.001 in both groups). After adjustment for potential confounders (including age and comorbidity), the estimated functional decline attributable to a hip fracture was 24% in the first year. Poor functional status upon discharge was the strongest predictor of a poor functional status at 1 year. Overall, similar trends were observed when using SF-36 scores as compared with RDRS-2 scores. However, only 51% of the study population was able to complete the SF-36 questionnaire at discharge and after 1 year, and these subjects were considerably younger (P<0.001), had less cognitive impairment (P<0.001), and had better functional status (P<0.001) than those who were unable to complete the SF-36. For those women able to complete the SF-36 questionnaires, the mean SF-36 score before hospital discharge was 56.4 (95% CI: 51.9–60.9) and 71.1 (67.5–74.8) in patients and controls, respectively (P<0.001). During the year following hospital discharge, the mean SF-36 score improved significantly to 61.1 (56.5–65.7) in hip-fracture patients (P=0.03), but remained unchanged in the control group (P=0.23). Overall, the results of this study indicate that women who sustain a hip fracture continue to suffer from substantial functional impairment and loss in QoL at 1 year, despite a significant recovery during this 12-month period. Function upon hospital discharge is the strongest predictor of functional status 1 year later. Assessing QoL in hip fracture women through self-administered questionnaires is subject to considerable bias due to non-response.The authors represent the Belgian Hip Fracture Study Group, the full membership of which comprises the following investigators: P. Autier, Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy, and Center for Research in Epidemiology and Health Information Systems Luxemburg, Grand Duchy of Luxemburg; J.M. Baillon, Department of Orthopedics, Ixelles-Etterbeek Hospital, Brussels, Belgium; M. Barette, Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Brussels, Belgium; J. Bentin, Service of Rheumatology, Louis Cathy Hospital, Baudourt, Belgium; S. Boonen, Leuven University Center for Metabolic Bone Diseases and Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; R. Bouillon, Leuven University Center for Metabolic Bone Diseases and Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium; P. Broos, Leuven University Center for Metabolic Bone Diseases and Division of Traumatology and Emergency Surgery, Katholieke Universiteit Leuven, Leuven, Belgium; M.C. Closon, Interdisciplinary Center in Health Economics, Université Catholique de Louvain, Brussels, Belgium; A.R. Grivegnée, Unit of Epidemiology and Prevention of Cancer, Jules Bordet Institute, Brussels, Belgium; P. Haentjens, Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium; P. Opdecam, Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium; D. Vanderschueren, Leuven University Center for Metabolic Bone Diseases and Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium.     

Risk factors for contra-lateral hip fracture in elderly patients with previous hip fracture

Introduction

Contra-lateral hip fractures in elderly patients with a previous hip fracture increase the incidence of complications and socioeconomic burden. The purpose of this study was to identify the risk factors that contribute to the occurrence of contra-lateral hip fracture in elderly patients.

Materials and methods

Among 1093 patients treated for a hip fracture, 47 patients sustained a contra-lateral hip fracture. These patients were compared with 141 patients with a unilateral hip fracture (controls).

Results

The incidence of contra-lateral hip fracture was 4.3% among the 1093 patients treated for a hip fracture at our institute. A contra-lateral hip fracture occurred within 2 years of initial fracture in 66%, and subsequently, the annual incidence rate decreased. A similar fracture pattern was noted in 70% of patients who sustained an intertrochanteric fracture. In terms of preoperative factors, respiratory disease (OR 2.57, P = 0.032) and visual impairment (OR 2.51, P = 0.012) were higher in patients with a contra-lateral hip fracture than in controls, and for postoperative factors, the proportions of patients with postoperative delirium (OR 2.91, P = 0.022), late onset of rehabilitation (OR 1.05, P = 0.023), and poor ambulatory status at 3 months (OR 1.34, P = 0.002) were also significantly higher in patients than in controls.

Conclusions

Postoperative delirium and underlying visual impairment and respiratory disease could be risk factors of contra-lateral fracture in elderly patients. Early and active rehabilitation after surgery is important to prevent the occurrence of contra-lateral hip fracture in the elderly.     

Hip axis length as an independent risk factor for hip fracture independently of femural bone mineral density in Caucasian elderly Brazilian women

Studies carried out in several countries and in different ethnic groups have suggested that the hip axis length (HAL) may be a risk factor for hip fractures.

To evaluate if the HAL is an independent risk factor for hip fractures in elderly Caucasian Brazilian women, this study includes 112 participants sustaining proximal femur osteoporosis. Through HAL and bone mineral density (BMD) measurements, a statistical analysis using a multivaried regression curve was done. HAL was significantly longer in women sustaining a hip fracture than in the control group (99.24 ± 5.9 mm vs. 96.95 ± 5.6 mm, P < 0.05). After adjusting the standard HAL deviation for neck and trochanter BMD, OR was 1.43 (IC 95% 0.29–1.07; P < 0.08). When HAL was categorized for 97.8 mm (average HAL in all women), OR was 2.24 (IC 95% 1.04–4.84; P < 0.05). In conclusion, HAL may be associated with risk of hip fracture regardless of age, weight or BMD of elderly Brazilian Caucasian women.     

Effect of alendronate in elderly patients after low trauma hip fracture repair

Summary

One year of once weekly alendronate, when given shortly after the surgical repair of a hip fracture, produces reductions in bone markers and increases proximal femoral bone density. The therapy was well tolerated.

Introduction

Hip fracture is the most devastating type of osteoporotic fracture and increases notably the risk of subsequent fractures. The aim of this paper was to evaluate the effects of 1 year therapy with a weekly dose of alendronate in the bone mineral density and bone markers in elderly patients after low trauma hip fracture repair.

Methods

Two hundred thirty-nine patients (81?±?7 years; 79.8% women) were randomized to be treated either with calcium (500 mg/daily) and vitamin D₃ (400 IU/daily; Ca–Vit D group) or with alendronate (ALN, 70 mg/week) plus calcium and vitamin D₃ (500 mg/daily and 400 IU/daily, respectively; ALN + Ca–Vit D group).

Results

One hundred forty-seven (61.5%) patients completed the trial. Alendronate increased proximal femoral bone mineral density (BMD) in the intention-to-treat analysis (mean difference (95% confidence interval); total hip 2.57% (0.67; 4.47); trochanteric 2.96% (0.71; 5.20), intertrochanteric 2.32% (0.36; 4.29)), but the differences were not significant in the BMD of the femoral neck (0.47%; (?2.03; 2.96) and the lumbar spine (0.69%; (?0.86; 2.23)). Bone turnover markers decreased during alendronate treatment.

Conclusion

The present study demonstrates for the first time the anti-resorptive efficacy of alendronate given immediately after surgical repair in an elderly population with recent hip fracture. This effect should positively affect the rate of subsequent fractures.     

Low serum concentrations of Irisin are associated with increased risk of hip fracture in Chinese older women

Objective

Irisin derived from muscle in response to exercise may be the molecular entity responsible for muscle wasting-osteoporosis connectivity in the elderly. The objective of the study was to determine whether serum Irisin (sIrisin) provides information on hip fracture prediction which were independent of bone mineral density (BMD) and the fracture risk assessment tool (FRAX) algorithm.

Alfacalcidol reduces accelerated bone turnover in elderly women with osteoporosis

To evaluate the effects of alfacalcidol on bone turnover in elderly women with osteoporosis, an open-label, prospective, calcium-controlled study was conducted. A total of 80 patients with osteoporosis were divided into two groups: the control group, group C (mean age, 78.0 years), in which patients were given calcium, and group D (mean age, 77.4 years), in which the patients were given alfacalcidol 1µg/day together with calcium for 6 months. Calcium regulation, lumbar bone mineral density (LBMD), and markers for bone turnover were assessed. A significant increase in urinary calcium/creatinine ratio (90% increase from baseline at 3 months; P = 0.0083, and 60% at 6 months; P = 0.0091) and a significant decrease in serum parathyroid hormone (30% decrease from baseline at 6 months; P < 0.0001) was observed in group D compared with the corresponding changes in group C. Significant decreases of bone resorption markers (deoxypyridinoline and N-telopeptide) at 6 months (about 15% decrease from the baseline values) were observed in group D compared with the corresponding changes in group C. The changes in bone formation markers (bone-derived alkaline phosphatase and osteocalcin) in group D were significantly different at 6 months (–21.5%; P = 0.0047 and –13.4%; P = 0.0032, respectively) from the values in group C. The magnitudes of the decrease in bone turnover markers were highly correlated with the corresponding baseline values, suggesting that alfacalcidol treatment effectively reduces bone turnover in patients with high bone turnover rates. The LBMD in group D increased by 1.7% and that in group C decreased by 1.6% (P = 0.0384). The changes in calcium metabolism and LBMD were in good agreement with those in previous reports. Although the changes in bone turnover markers in group D were slight, significant reduction in bone turnover with alfacalcidol treatment, together with the change in calcium metabolism, may account for the effects of alfacalcidol on BMD and on fracture prevention reported previously. In conclusion, alfacalcidol reduces bone turnover in elderly women with high-bone-turnover osteoporosis, and it may have beneficial effects on bone.     

骨密度结合股骨近端几何参数预测老年髋部骨折

目的研究老年人骨密度(Bone mineral density,BMD)值结合股骨近端几何参数是否能提高骨质疏松性髋部骨折危险性的预测。方法将85例绝经后妇女髋部骨折患者按骨折类型分组, 其中52例股骨颈骨折,33例转子间骨折。对照组100例老年女性。在骨盆片上测量股骨近端几何参数,在股骨颈、Ward’s三角和转子处测量BMD值,对结果进行统计学处理分析。结果骨折组的BMD值均低于对照组(P<0．01);股骨干皮质厚度与股骨颈BMD值有相关性(r=0．45,P< 0．01);逐步线性回归分析结果显示股骨距内侧皮质厚度、转子处BMD值、颈干角和Ward’s三角 BMD值相结合是预测髋部骨折最好方法(r=0．74,r2=0．53,P<0．01)。结论骨密度值结合放射学测量股骨近端几何参数能提高对骨质疏松性髋部骨折及骨折类型的预测。     

Femoral and spinal bone mineral density in Japanese osteoporotics with hip fracture

In the present study, bone mineral density (BMD) of femoral neck and lumbar spine was compared between 38 Japanese female patients with hip fracture (age 63–89 years, mean±SD 76±7 years) and 162 age-matched female controls (age 62–90 years, mean±SD 75±7 years). BMD was measured in the femoral neck and lumbar spine (L2–4) using dual-photon absorptiometry (Norland model 2600). BMD values of femoral neck as well as lumbar spine were significantly lower in patients with hip fracture than in controls (0.504±0.097 v 0.597±0.101,p<0.01, for femoral neck; 0.661±0.146 v 0.720±0.128,p<0.05, for lumbar spine). Patients with hip fracture and controls were stratified according to their BMD levels at two measuring sites, and the ratio of the number of patients and controls at each BMD level was calculated as an indicator of fracture rate. This ratio showed an exponential increase as the femoral neck BMD declined, but only a gradual increase as the lumbar spine BMD declined. Specificity-sensitivity analysis revealed that BMD values of 0.59 and 0.54 g/cm² at the femoral neck provided a specificity of 52% and 68% with a sensitivity of 90% and 75%, respectively. These findings suggest that Japanese patients with hip fracture are more osteoporotic than age-matched controls and that the selective measurement of femoral neck would be useful for predicting the risk of hip fracture.     

Ultrasound bone densitometry of Os calcis in elderly Japanese women with hip fracture

We evaluated 138 elderly patients (mean age 79 years) within 2 weeks after hip fracture (67 cervical and 71 trochanteric) using an Achilles ultrasound bone densitometer (Lunar Corporation, Madison, WI). The ultrasound variables of speed of sound (SOS in m/second), broadband ultrasound attenuation (BUA in dB/MHz), and stiffness (%) index were measured on the os calcis. Ultrasound densitometry also was done on 563 normal postmenopausal women to assess normal age changes. An elderly subgroup (n = 138) served as age-matched controls for the hip fracture group. Further subgroups of 33 patients and 33 controls were compared for lumbar spine and femoral neck BMD. There were no statistically significant differences between the hip fracture group and age-matched controls in height and weight, but each ultrasound variable was significantly lower for the hip fracture group (P < 0.0001). For the hip fracture group, SOS was 1470 ± 19 m/second, BUA was 84.3 ± 8.4 dB/MHz, and the stiffness index was 47.8 ± 9.2%, whereas for the age-matched controls, SOS was 1486 ± 27 m/second, BUA was 94.0 ± 11.4 dB/MHz, and the stiffness index was 59.1 ± 12.5%. There were no significant differences between cervical and trochanteric hip fracture groups. Logistic regression analysis showed that a change of the ultrasound values by 1 standard deviation (SD) changed the odds ratio for SOS, BUA, and stiffness index by 2.51, 3.24, and 3.60, respectively. Ultrasound variables, particularly stiffness, were good indicators of hip fracture risk. Received: 7 June 1995 / Accepted: 14 June 1996     

E3醚防止老年妇女骨量丢失作用的探讨

本文对２５例绝经年限分别为５～１２年（低绝经年限组）和１５～２８年（老年妇女组）两组妇女分别给予Ｅ３醚用药２个月，于给药前后分别进行桡骨骨矿含量（ＢＭＣ）的测定、空腹尿钙与肌酥（Ｃａ／Ｃｒ）、羟脯氨酸与肌酐（ＯＨＰｒ／Ｃｒ）比值以及血清碱性磷酸酶（ＡＫＰ）、雌二醇（Ｅ２）、降钙素（ＣＴ）的测定，以探讨Ｅ３醚减缓不同绝经年限的妇女骨量丢失的作用机制。结果显示：Ｅ３醚给药前后两组妇女ＢＭＣ和血清Ｅ２的水平未见明显的变化，但其血清ＣＴ的水平均较给药前有程度不同的升高。空腹尿Ｃａ／Ｃｒ、ＯＰＨｒ／Ｃｒ比值以及血清ＡＫＰ的水平均较给药前显著下降（ｐ＜０．０５及ｐ＜０．０１）。故此提示：Ｅ３酸可能通过刺激甲状腺Ｃ细胞而增加ＣＴ的分泌或直接作用于骨组织等多种途径抑制骨质的吸收，维持骨矿含量的相对稳定。因此，本研究为Ｅ３醚用于减缓老年妇女骨量丢失的作用途径提供了一定的实验依据。     

骨折病史对中老年人群髋部骨密度影响的研究

目的 利用NHANES数据库分析50岁之前骨折病史是否影响患者50岁后的髋部骨密度。方法 纳入NHANES数据库5个调查年份的人群数据,通过筛查选出完成髋部骨密度检查并完成自我报告骨折病史调查者,通过统计学分析比较骨折组与非骨折组髋部骨密度的差异。结果 共纳入研究个体10 476例,其中非骨折组9 536人,骨折组940人,骨折组男性比率明显高于女性。骨折组人群平均年龄(62.8±9.1)岁,BMI值(29.24±5.77) kg/m2,非骨折组人群平均年龄(64.7±9.5)岁,BMI值为(28.55±5.59) kg/m2,结果差异有统计学意义。骨折组人群的合并症中肾功能障碍及关节炎显著高于非骨折组。协方差分析结果提示骨折组的髋部骨密度,股骨颈、大转子、转子间及Ward三角骨密度均显著下降。亚组分析结果显示髋部骨折组及腕部骨折组的骨密度均显著下降,而脊柱骨折组患者骨密度差异无统计学意义。结论 50岁之前骨折病史将会导致患者50岁之后髋部骨密度显著下降,尤其是腕部骨折及髋部骨折病史。     

老年髋部骨折患者术后对侧髋部骨折发生因素的Meta分析

目的通过Meta分析评价影响老年髋部骨折患者术后对侧髋部骨折的相关因素。方法检索Pubmed、Cochrane、中国生物医学文献数据库、CNKI中国期刊全文数据库、万方数据库自2005年1月至2018年4月国内外正式刊物上公开发表的有关老年髋部骨折术后对侧髋部骨折相关因素的文献,严格评价质量及提取相关资料,获取患者的性别、年龄(>65岁)、吸烟、初次髋部骨折类型、骨质疏松症(Singh指数≥4为骨质疏松)、伴有原发性高血压、伴有帕金森病、伴有脑卒中、伴有老年痴呆症、伴有白内障、伴有类风湿关节炎、伴有糖尿病、初次骨折内固定种类、患者治疗配合的依从性。运用RevMan5.0软件进行统计分析,评估各项指标的优势比(OR)和95%可信区间(CI)。结果共纳入17项研究13717例老年髋部骨折患者,发生对侧髋部骨折1504例。影响老年髋部骨折术后对侧髋部骨折的相关因素有患者年龄(OR=-3.55,95%CI:-5.60^-1.50,P<0.001)、骨质疏松症(OR=2.38,95%CI:1.36~4.17,P=0.002)、伴有帕金森病(OR=4.54,95%CI:2.74~7.53,P<0.001)、脑卒中(OR=0.33,95%CI:0.18~0.59,P<0.001)、老年痴呆症(OR=0.43,95%CI:0.29~0.62,P<0.001)、白内障(OR=0.37,95%CI:0.22~0.63,P<0.001)、类风湿关节炎(OR=0.32,95%CI:0.21~0.50,P<0.001)、糖尿病(OR=0.65,95%CI:0.47~0.91,P=0.01)、初次骨折内固定种类(OR=0.51,95%CI:0.30~0.85,P=0.01)、治疗配合依从性(OR=0.36,95%CI:0.21~0.64,P<0.001),而与性别(OR=1.07,95%CI:0.45~2.56,P=0.88)、吸烟(OR=0.86,95%CI:0.40~1.86,P=0.70)、初次髋部骨折类型(OR=0.97,95%CI:0.60~1.57,P=0.90)、伴有原发性高血压(OR=0.70,95%CI:0.41~1.21,P=0.20)无关。结论影响老年髋部骨折患者术后对侧髋部骨折的相关因素有年龄偏大、伴有骨质疏松症、帕金森病、脑卒中、老年痴呆症、白内障、类风湿关节炎、糖尿病、初次骨折内固定种类、治疗配合依从性差。而患者性别、吸烟、骨折类型、伴有原发性高血压目前尚无足够的证据与对侧髋部骨折有关。     

Impaired geometric properties of tibia in older women with hip fracture history

Summary This study evaluated side-to-side differences in tibial mineral mass and geometry in women with previous hip fracture sustained on average 3.5 years earlier. Both tibial mineral mass and geometry were found to be reduced in the fractured leg. Introduction The purpose of this study was to evaluate side-to-side differences in tibial mineral mass and geometry after hip fracture and to assess the determinants of such differences. Methods Thirty-eight 60- to 85-year-old women with a previous hip fracture and 22 same-aged control women without fractures participated in the study. Bone characteristics of the distal tibia and tibial shaft of both legs were assessed using pQCT in order to compare the side-to-side differences of tibias between the two groups. Results The subjects with fracture history had significantly (p ≤ 0.05, analysis of covariance) larger side-to-side differences than the controls in tibial shaft BMC (−4.9% vs. −0.5%), cortical area (−5.2% vs. 0.1%) and polar moment of inertia (I_polar) (−5.6% vs. −0.8%) and in distal tibia BMC (−5.1% vs. −1.4%) and I_polar (−7.5% vs. −2.4%). In the fracture patients, the side-to-side differences in muscle characteristics explained 23 to 44% of the variances in the side-to-side differences in bone mass and geometry. Conclusions Hip fracture results in reduced bone mass and impaired bone geometry in the tibia of the affected limb in older women. Muscle-induced loading may have a considerable role in the recovery of bone mineral mass and geometry after hip fracture.     

Increased bone density and decreased bone turnover, but no evident alteration of fracture susceptibility in elderly women with diabetes mellitus

Bone density, bone turnover and fracture susceptibility were evaluated in 1,132 randomly recruited women, all 75 years old. Seventy-four of the women had diabetes, while 1,058 women did not. Areal bone mineral density (aBMD) of the hip and lumbar spine was investigated by dual energy X-ray absorptiometry (DXA), and bone mass of the calcaneus was measured by ultrasound. Urinary deoxypyridinoline/creatinine (U-DPD/Crea) and serum C-terminal cross-linked telopeptide of type 1 collagen (S-CTX) were assessed as markers of bone resorption. Serum bone-specific alkaline phosphatase (S-bone ALP) and serum osteocalcin (S-OC) were assessed as markers of bone formation. Also, serum 25(OH) vitamin D and serum parathyroid hormone (S-PTH) were assessed. Fracture susceptibility was evaluated retrospectively and prospectively for up to 6.5 years. In diabetic women, the aBMD of the femoral neck was 11% higher ( p <0.001), and BMD of the lumbar spine was 8% higher ( p =0.002) than in non-diabetic women. There was no difference in bone mass by ultrasound of the calcaneus. Women with diabetes had higher BMD of the femoral neck ( p <0.001) and lumbar spine ( p =0.03) also after correction for differences in body weight. In diabetic women, U-DPD/Crea, S-CTX, and S-OC were decreased when compared with non-diabetic women ( p =0.001 or less). After correction for covariance of body weight and plasma creatinine, S-CTX ( p <0.001) and S-OC ( p <0.001) were still lower in the diabetic women. Diabetic patients had hypovitaminosis D ( p =0.008), a difference explained by differences in time spent outdoors and body weight. S-PTH did not differ between the groups. Women with diabetes had no more lifetime fractures (52%) than women without diabetic disease (57%), ( p =0.31). This study shows that elderly women with diabetes and without severe renal insufficiency have high bone mass and low bone turnover. The high bone mass and low bone turnover is not likely to have a strong influence on fracture susceptibility.     

Predictors of bone loss after hip fracture

Although accelerated bone mineral density (BMD) loss follows hip fracture, little is known about factors associated with this loss. We examined potential predictors of BMD loss in a cohort of community-dwelling women who had sustained hip fracture and who were followed for 1 year after fracture. BMD was measured at the femoral neck, intertrochanteric region, and total body, during hospitalization and 2, 6, and 12 months later. Demographic, health, lifestyle, clinical, surgical, and functional characteristics at baseline, and postfracture activity were evaluated for associations with baseline BMD and BMD 1 year later. To examine possible BMD-dependent effects, high and low baseline BMD groups were defined. None of the studied factors consistently predicted either baseline BMD or BMD at 1 year after fracture, among women with either high or low baseline BMD. Baseline BMD was the only factor that substantially and consistently predicted change, explaining 70% to 90% of variation. These results suggest that BMD will not be preserved by general rehabilitative measures and that prompt, specific intervention to minimize bone loss after hip fracture is an essential element of clinical management of the hip fracture patient.     

Femur strength index predicts hip fracture independent of bone density and hip axis length

Introduction Proximal femoral bone strength is not only a function of femoral bone mineral density (BMD), but also a function of the spatial distribution of bone mass intrinsic in structural geometric properties such as diameter, area, length, and angle of the femoral neck. Recent advancements in bone density measurement include software that can automatically calculate a variety of femoral structural variables that may be related to hip fracture risk. The purpose of this study was to compare femoral bone density, structure, and strength assessments obtained from dual-energy X-ray absorbtiometry (DXA) measurements in a group of women with and without hip fracture. Methods DXA measurements of the proximal femur were obtained from 2,506 women 50 years of age or older, 365 with prior hip fracture and 2,141 controls. In addition to the conventional densitometry measurements, structural variables were determined using the Hip Strength Analysis program, including hip axis length (HAL), cross-sectional moment of inertia (CSMI), and the femur strength index (FSI) calculated as the ratio of estimated compressive yield strength of the femoral neck to the expected compressive stress of a fall on the greater trochanter. Results Femoral neck BMD was significantly lower and HAL significantly higher in the fracture group compared with controls. Mean CSMI was not significantly different between fracture patients and controls after adjustment for BMD and HAL. FSI, after adjustment for T score and HAL, was significantly lower in the fracture group, consistent with a reduced capacity to withstand a fall without fracturing a hip. Conclusion We conclude that BMD, HAL, and FSI are significant independent predictors of hip fracture.