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1.
N. Boonyaratavej P. Suriyawongpaisal A. Takkinsatien S. Wanvarie R. Rajatanavin P. Apiyasawat 《Osteoporosis international》2001,12(3):244-248
Hip fractures are among the most important causes of ill health and death among elderly people. Several potentially modifiable
risk factors have been reported. Most claimed physical activity as a promising, inexpensive preventive measure for hip fracture.
However, knowledge about risk factors for hip fracture in Asian populations is very limited. We therefore conducted a case–control
study to assess the relationships between physical activity and risk of hip fractures in Thai women. From 14 hospitals in
Thailand, 229 cases with a radiologically confirmed first hip fracture were enrolled. Two hundred and twenty-four controls
were randomly recruited from the same neighborhood and were matched to the cases by age within a 5 year range. Information
on physical activity as well as other potential confounders was obtained through personal interviews. Multivariate logistic
regression revealed that past physical activity was protective in both very active and active women (OR = 0.67, 95% CI = 0.40–1.12
for moderately active women and OR = 0.20, 95% CI = 0.10–0.38 for very active women; p value for trend <0.01). Recent physical activity reduced the risk to about two-thirds (OR = 0.33, 95% CI = 0.19–0.60 and
OR = 0.35, 95% CI = 0.18–0.69 for moderately and very active women respectively). In addition, breastfeeding was identified
to be a protective factor (OR = 0.87, 95% CI = 0.80–0.94). In contrast, the following risk factors were identified: current
use of antihistamine (OR = 13.96, 95% CI = 1.38–141.13) or traditional medicine (OR = 7.66, 95% CI = 2.71–21.63), underlying
cerebrovascular diseases (OR = 6.53, 95% CI = 2.10–20.34), history of fracture (OR = 4.04, 95% CI = 1.26–12.99), parental
Chinese racial background (OR = 2.52, 95% CI = 1.49–4.23), alcohol consumption (OR = 2.30, 95% CI = 1.04–5.09).
Received: 14 April 2000 / Accepted: 17 October 2000 相似文献
2.
Socioeconomic Status, Marital Status and Hip Fracture Risk: A Population-Based Case–Control Study 总被引:3,自引:0,他引:3
B. Y. Farahmand P.-G. Persson K. Michaëlsson J. A. Baron M. G. Parker S. Ljunghall 《Osteoporosis international》2000,11(9):803-808
Socioeconomic status and social support have been identified as important determinants of several diseases and overall mortality,
but these factors have not been adequately examined in relation to hip fracture risk. The aim of this study was to determine
the relationship of socioeconomic status and marital status to hip fracture risk. We used data from a population-based case–control
study in postmenopausal women aged 50–81 years during 1993–1995 who resided in six counties in Sweden. The analysis was based
on 1327 incident cases of hip fracture and 3262 randomly selected controls. Socioeconomic and marital status were obtained
by record linkage with census data in 1960, 1970, 1980 and 1990. Information on other possible risk factors for hip fracture
was collected by a mailed questionnaire. Women who were gainfully employed in 1990 had an odds ratio (OR) of 0.74 [95% confidence
interval (CI) 0.56–0.96] compared with those not gainfully employed; those in the highest tertile of household income had
an OR of 0.74 (95% CI 0.60–0.90) compared with those in the lowest tertile of income. Women who lived in a one-family house
had an OR of 0.85 (95% CI 0.72–0.99) compared with those living in an apartment. Divorced, widowed or unmarried women had
a higher risk of hip fracture than married or cohabiting women; the OR was 1.40 (95% CI 1.06–1.85). Married women who were
both gainfully employed and were living in a one-family house had a substantially decreased risk of hip fracture compared
with unemployed women living without a partner in an apartment (OR 0.39; 95% CI 0.22–0.71). Occupational affiliation among
women ever employed, and educational level, were not associated with hip fracture risk. We conclude that employment, household
income, type of housing and marital status seem to be risk indicators of hip fracture risk independent of known osteoporotic
risk factors.
Received: 6 October 1999 / Accepted: 29 March 2000 相似文献
3.
The steep rise in hip fracture incidence rates with age is not fully explained by an increase in the frequency of falls or
by reduction in bone mineral density, suggesting that circumstances of falls may also affect the risk of hip fracture. Previous
studies conducted mainly among women have identified the importance of the orientation of a fall in the etiology of hip fracture.
In this case–control study among men of 45 years and older, we evaluated how the circumstances of falls affect the risk of
hip fracture. We compared 214 cases with hip fracture due to a fall with 86 controls who had fallen within the past year but
did not sustain a hip fracture. As expected, in multivariable age-adjusted analyses men who reported hitting the hip/thigh
in a fall had a markedly elevated risk of hip fracture (OR = 97.8; 95% CI = 31.7–302). Hitting the knee in a fall was associated
with reduced risk (OR = 0.24; 95% CI = 0.09–0.67). Other factors that were associated with reduced risk of hip fracture among
men who fell were more hours of physical activity in the past year (OR = 0.84; 95% CI = 0.73–0.97, for each additional 4 h
per week), a greater body mass index (OR = 0.60; 95% CI = 0.40–0.90, for each additional 4 kg/m2), and a history of a fracture when age 45 years or older (OR = 0.26; 95% CI = 0.10–0.69). Reported lower limb dysfunction
was associated with increased risk of hip fracture (OR = 6.41; 95% CI = 2.09–19.6) among fallers. The increased risk associated
with hitting the hip/thigh in a fall and the reduced risk associated with high body mass index suggest that preventive efforts
for older men at high risk might include protective hip pads to reduce the force on the hip in a fall. Exercise and strength
training programs may also reduce the risk of hip fracture among men who fall.
Received: 12 May 1997 / Accepted: 14 October 1997 相似文献
4.
K. Michaëlsson E. Weiderpass B. Y. Farahmand J. A. Baron P.-G. Persson L. Zidén C. Zetterberg S. Ljunghall 《Osteoporosis international》1999,10(6):487-494
The two types of hip fracture – cervical and trochanteric femoral fractures – are generally considered together in etiologic
studies. However, women with a trochanteric fracture may be more osteoporotic than those with cervical hip fractures, and
have higher post-fracture mortality. To explore differences in risk factor patterns between the two types of hip fracture
we used data from a large population-based case–control study in Swedish women, 50–81 years of age. Data were collected by
questionnaire, to which more than 80% of subjects responded. Of the cases included, 811 had had a cervical fracture and 483
a trochanteric fracture during the study period; these cases were compared with 3312 randomly selected controls. Height and
hormonal factors appeared to affect the risk of the two types of hip fracture differently. For every 5 cm of current height,
women with a cervical fracture had an adjusted odds ratio (OR) of 1.23 (95% CI 1.15–1.32) compared with an OR of 1.06 (95%
CI 0.97–1.15) for women with trochanteric fractures. Later menopausal age was protective for trochanteric fractures (OR 0.95,
95% CI 0.91–0.99 per 2 years) but no such association was found for cervical fractures. Compared with never smokers, current
smokers had an OR of 1.48 (95% CI 1.12–1.95) for trochanteric fractures and 1.22 (95% CI 0.98–1.52) for cervical fractures.
Current hormone replacement therapy was similarly protective for both fracture types, but former use substantially reduced
risk only for trochanteric fractures: OR 0.55 (95% CI 0.33–0.92) compared with 1.00 (95% CI 0.71–1.39) for cervical fractures.
These risk factor patterns suggest etiologic differences between the fracture types which have to be considered when planning
preventive interventions.
Received: 22 March 1999 / Accepted: 28 May 1999 相似文献
5.
Risk Factors for Perimenopausal Fractures: A Prospective Study 总被引:11,自引:6,他引:5
J. Huopio H. Kröger R. Honkanen S. Saarikoski E. Alhava 《Osteoporosis international》2000,11(3):219-227
This prospective study was aimed at determining the risk factors for the development of fractures in perimenopausal women.
The study group (n= 3068) was comprised of a stratified population sample of women aged between 47 and 56 years. During the follow-up period
of 3.6 years, 257 (8.4%) of the women sustained a total of 295 fractures. After adjustment for covariates, the relative risk
(RR) of sustaining a fracture was found to be 1.4 [95% confidence interval (CI) 1.2–1.6] for a 1 standard deviation (SD) decrease
in the spinal and femoral neck bone mineral density (BMD). Women with a previous fracture history were found to have an increased
risk of fracture [RR 1.7 (95% CI 1.3–2.2)] and those reporting three or more chronic illnesses exhibited a RR of 1.4 (95%
CI 1.0–1.9). Women not using hormone replacement therapy (HRT) had a RR of 1.5 (95% CI 1.1–2.2) for all fracture types. When
osteoporotic fractures (vertebral, hip, proximal humerus and wrist fractures; n= 98) were used as an endpoint, the independent risk factors were found to be a low BMD (RR for a 1 SD decrease in both spinal
and femoral neck BMD was 1.6, 95% CI 1.3–2.0), a previous fracture history (RR 1.9, 95% CI 1.3–2.9) and nonuse of HRT (RR
2.2, 95% CI 1.3–4.0). The independent risk factors for all other fractures (n = 158) were a low BMD (RR for a 1 SD decrease in the spinal BMD was 1.4, 95% CI 1.2–1.6 and in the femoral neck BMD was 1.3,
95% CI 1.1–1.5), a previous fracture history (RR 1.6, 95% CI 1.1–2.2), smoking (RR 1.8, 95% CI 1.1–2.7) and having had three
or more chronic illnesses (RR 1.6, 95% CI 1.1–2.2). Weight, height, age, menopausal status, maternal hip fracture, use of
alcohol, coffee consumption or dietary calcium intake were not independently associated with the development of any particular
type of fracture. We conclude that the independent risk factors for perimenopausal fractures are a low bone density, previous
fracture history, nonuse of HRT, having had three or more chronic illnesses and smoking, the gradient of risk being similar
for spinal and femoral neck BMD measurements in the perimenopausal population. The risk factors are slightly different for
perimenopausal osteoporotic than for other types of fractures.
Received: 6 April 1999 / Accepted: 18 August 1999 相似文献
6.
T. S. Wei C. H. Hu S. H. Wang K. L. Hwang
Departments of 《Osteoporosis international》2001,12(12):1050-1055
Hip fracture is the most serious consequence of osteoporosis, frequently occurring in the elderly; however, no research has
been performed to identify the fall characteristics, functional mobility and bone mineral density (BMD) concurrently as risk
factors. We investigated the risk factors of hip fractures using a multifactorial approach for a further preventive strategy.
This age- and sex-matched case-control study was conducted in a community-based general hospital. A total of 252 consecutive
community-dwelling ambulatory elderly, aged between 65 and 85 years, were studied: 127 patients (faller with hip fracture)
and 125 controls (faller without hip fracture). Body mass index (BMI), predisposing medical conditions, fall characteristics,
functional mobility and BMD of the hip were evaluated by direct interview and clinical examination. In the final model of
multivariate regression analysis, risk factors for hip fracture were direct hip impact (adjusted odds ratio (OR), 4.9; 95%
confidence interval (CI), 2.7–8.8), previous stroke (adjusted OR, 2.9; 95% CI, 1.3–6.3), sideways fall (adjusted OR, 2.5;
95% CI, 1.6–3.9), functional mobility (a decrease of 1 SD; adjusted OR, 2.0; 95% CI, 1.1–3.5), BMI (a decrease of 1 SD; adjusted
OR, 1.8; 95% CI, 1.1–2.8) and femoral neck BMD (a decrease of 1 SD; adjusted OR, 1.7; 95% CI, 1.0–2.8). The effect of risk
factors remained the same in different analysis sets, and adding or removing femoral neck BMD did not change other risk factors,
though BMD was significantly correlated with functional mobility and BMI. Importantly, both sideways fall and direct hip impact
are independent predictors of hip fracture. From these results, we suggest a preventive strategy of hip fracture in the elderly:
besides the maintenance of BMD, keeping an appropriate body weight and maintaining a physically active lifestyle might be
crucial.
Received: 11 January 2001 / Accepted: 6 July 2001 相似文献
7.
Unbalanced Diet to Lower Serum Cholesterol Level is a Risk Factor for Postmenopausal Osteoporosis and Distal Forearm Fracture 总被引:1,自引:1,他引:0
M. Varenna L. Binelli F. Zucchi D. Ghiringhelli L. Sinigaglia 《Osteoporosis international》2001,12(4):296-301
The purpose of this study was to assess whether dietary changes aimed at reducing serum cholesterol can increase the risk
of osteoporosis (OP) and fracture. The study group consisted of 311 postmenopausal women with high serum cholesterol levels
and following a diet low in dairy products (calcium intake estimated at less than 300 mg/day) for 27.3 ± 29.1 months. This
sample was compared with a case–control group of 622 healthy postmenopausal women paired for age and age at menopause and
with a calcium intake estimated at more than 1 g/day. Bone mineral density was measured at the lumbar spine by dual-energy
X-ray absorptiometry. Prevalence of OP was significantly higher in women with a low dairy calcium intake (42.1% vs 22.3%; p<0.0001), as was the number of Colles” fractures occurring after menopause (4.5% vs 1.6%; p = 0.008). Multiple logistic regression analyses demonstrated that a diet low in dairy calcium was a risk factor for OP (OR
= 2.52, 95% CI 1.84–3.45) and Colles” fracture (OR = 2.72, 95% CI 1.18–6.26). In the low dairy calcium group, diet duration
significantly influenced the risk of OP (OR = 1.13, 95% CI 1.01–1.25 for 1 year of diet). No differences in further risk factors
for coronary heart disease were found between the groups, but the proportion of women physically active was lower in the women
with high serum cholesterol levels. A diet that severely limits calcium intake from dairy products in an attempt to correct
raised serum cholesterol levels is a risk factor for postmenopausal OP and Colles” fracture. Dietary intervention methods
to lower serum cholesterol in postmenopausal women should maintain an adequate calcium intake by providing calcium from low-fat
dairy products or calcium supplements.
Received: 16 May 2000 / Accepted: 18 November 2000 相似文献
8.
The ability of quantitative ultrasound (QUS) to estimate the risk of osteoporotic fractures was evaluated in a prospective
study over a mean time of 5.47 years in 254 postmenopausal women (mean age 58.06 ± 7.67 years). Baseline measurements of ultrasound
transmission velocity (UTV) and bone mineral density (BMD) were taken at the distal radius (DR). UTV was also measured at
the patella (P). Fifty nonspine fractures due to minor trauma were detected during annual check-ups with an incidence of 3.59/year.
Fractures occurred in older women with a lower BMD and QUS. Using Cox regression analysis the relative risk (RR) per 1 standard
deviation (SD) decrease in the unadjusted QUS and BMD measurements was: BMD-DR = 3.56, 95% confidence interval (CI) 1.57–8.09;
UTV-DR = 5.35, 95% CI 2.07–13.83; UTV-P = 4.49, 95% CI 2.08–9.68. The relationship between BMD and QUS variables and fracture
risk persisted after adjusting for potential confounders apart from previous fractures, giving the following RR: BMD-DR =
2.99, 95% CI 1.06–8.41; UTV-DR = 3.69, 95% CI 1.18–11.49; UTV-P = 3.89, 95% CI 1.53–9.90. Correcting also for previous fractures,
only UTV-P remained an effective predictor of fracture risk even after QUS measurement correction for BMD. Wrist fractures
were best related to BMD-DR (RR 7.33, 95% CI 1.43–37.50) and UTV-DR (RR 10.94, 95% CI 1.10–108.45), while hip and ankle fractures
were significantly associated only with UTV-P (hip: RR 32.14, 95% CI 1.83–562.80; ankle: RR 17.60, 95% CI 1.78–173.79). The
combined use of BMD and QUS is a better predictor of fracture risk than either technique used separately. Comparison of the
areas under the receiver operating characteristic (ROC) curves did not show differences in the ability of BMD and QUS to correctly
distinguish fractures. In conclusion, QUS predicts fracture risk in osteoporotic women at least as well as BMD. UTV-DR and
BMD-DR are good predictors of wrist fractures, while UTV-P is strongly related to hip and ankle fractures. QUS and BMD combined
improve the diagnostic ability of each technique individually.
Received: 27 April 1999 / Accepted: 3 December 1999 相似文献
9.
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
10.
Survival after Hip Fracture: Short- and Long-Term Excess Mortality According to Age and Gender 总被引:5,自引:5,他引:0
L. Forsén A. J. Søgaard H. E. Meyer T.-H. Edna B. Kopjar 《Osteoporosis international》1999,10(1):73-78
The purpose of this study was to analyze the excess mortality after hip fracture and to reveal whether, and eventually when,
the excess mortality vanished in different groups of age and gender. A population-based, prospective, matched-pair, cohort
study among persons 50 years of age and older was conducted involving 1338 female and 487 male hip fracture patients with
11 086 and 8141 controls respectively. Occurrence of hip fracture and mortality were recorded from 1986 until 1995. We studied
the excess mortality of the hip fracture patients versus controls by using Kaplan–Meier curves and extended Cox regression
with hip fracture (yes/no) as time-dependent covariate. The male hip fracture patients had higher mortality than the women
the first year after the injury, irrespective of age, both in absolute terms (31% and 17% respectively) and relative to their
age-matched controls. The relative risk (RR) of dying within 1 year for hip fracture patients versus controls was 3.3 (95%
confidence interval (CI) 2.1–5.2) for women and 4.2 (95% CI 2.8–6.4) for men below 75 years of age. The corresponding figures
for persons 85 years and older were 1.6 (95% CI 1.2–2.0) for women and 3.1 (95% CI 2.2–4.2) for men. All groups of age and
gender, except women 85 years and older, had a large and significant excess mortality lasting for many years after the hip
fracture – at least 5–6 years for women below 75 years of age (RR = 3.2, 95% CI 1.9–5.6). The excess mortality after hip fracture
for women 85 years and older had vanished after 3 months (RR = 1.0, 95% CI 0.8–1.1). When referring to the excess mortality
after hip fracture it is therefore necessary to specify sex, age and time since injury.
Received: 15 September 1998 / Accepted: 23 December 1998 相似文献
11.
Proximal Femur Geometry To Detect and Distinguish Femoral Neck Fractures from Trochanteric Fractures in Postmenopausal Women 总被引:19,自引:4,他引:15
S. Gnudi C. Ripamonti L. Lisi M. Fini R. Giardino G. Giavaresi 《Osteoporosis international》2002,13(1):69-73
Some proximal femur geometry (PFG) parameters, measured by dual-energy X-ray absorptiometry (DXA), have been reported to
discriminate subjects with hip fracture. Relatively few studies have tested their ability to discriminate femoral neck fractures
from those of the trochanter. To this end we performed a cross-sectional study in a population of 547 menopausal women over
69 years of age with femoral neck fractures (n= 88), trochanteric fractures (n= 93) or controls (n= 366). Hip axis length (HAL), neck–shaft angle (NSA), femoral neck diameter (FND) and femoral shaft diameter (FSD) were measured
by DXA, as well as the bone mineral density (BMD) of the nonfractured hip at the femoral neck, trochanter and Ward’s triangle.
In fractured subjects, BMD was lower at each measurement site. HAL was longer and NSA wider in those with femoral neck fractures.
With logistic regression the age-adjusted odds ratio (OR) for a 1 standard deviation (SD) decrease in BMD was significantly
associated at each measurement site with femoral neck fracture (femoral neck BMD: OR 1.9, 95% confidence interval (95% CI):
1.4–2.5; trochanter BMD: OR 1.6, 95% CI 1.2–2.0; Ward’s triangle BMD: OR 1.7, 95% CI 1.3–2.2) and trochanteric fracture (femoral
neck BMD: OR 2.6, 95% CI 1.9–3.6; trochanter BMD: OR 3.0, 95% CI 2.2–4.1; Ward’s triangle BMD: OR 1.8, 95% CI 1.4–2.3). Age-adjusted
OR for 1 SD increases in NSA (OR 2.2, 95% CI 1.7–2.8) and HAL (OR 1.3, 95% CI 1.1–1.6) was significantly associated with the
fracture risk only for femoral neck fracture. In the best predictive model the strongest predictors were site-matched BMD
for both fracture types and NSA for neck fracture. Trochanteric BMD had the greatest area (0.78, standard error (SE) 0.02)
under the receiver operating characteristic curve in trochanteric fractures, whereas for NSA (0.72, SE 0.03) this area was
greatest in femoral neck fractures. These results confirm the association of BMD with proximal femur fracture and support
the evidence that PFG plays a significant role only in neck fracture prediction, since NSA is the best predictive parameter
among those tested.
Received: 24 April 2001 / Accepted: 1 August 2001 相似文献
12.
Forearm Fractures as Predictors of Subsequent Osteoporotic Fractures 总被引:11,自引:0,他引:11
M.-T. Cuddihy S. E. Gabriel C. S. Crowson W. M. O’Fallon L. J. Melton III 《Osteoporosis international》1999,9(6):469-475
To assess the ability of distal forearm fractures to predict future fractures, we conducted a population-based retrospective
cohort study among the 1288 residents (243 men, 1045 women) of Rochester, Minnesota age 35 years or older who experienced
their first distal forearm fracture in 1975–94. During 9664 person-years of follow-up, 548 patients experienced 1109 subsequent
fractures, excluding 195 that occurred on the same day as the index forearm fracture. The cumulative incidence of any subsequent
fracture was 55% by 10 years and 80% by 20 years following the initial distal forearm fracture. Compared to expected fracture
rates in the community, the risk of a hip fracture following the index forearm fracture was increased 1.4-fold in women (95%
CI, 1.1–1.8) and 2.7-fold in men (95% CI, 0.98–5.8). In women, the risk of hip fracture differed by age, as we had found in
a previous study. Women over age 70 had a 1.6-fold increase (95% CI, 1.2–2.0) in subsequent hip fracture risk whereas women
who sustained their first forearm fracture before age 70 years did not have significantly increased risk. By contrast, vertebral
fractures were significantly increased at all ages, with a 5.2-fold increase (95% CI, 4.5–5.9) in risk among women and a 10.7-fold
increase (95% CI, 6.7–16.3) among men following a first distal forearm fracture. The increased risk in men suggests that a
sentinel forearm fracture should not be ignored. Among the women, we also found a missed opportunity for intervention as hormone
replacement therapy was underutilized.
Received: 8 May 1998 / Accepted: 16 October 1998 相似文献
13.
Femoral Neck and Intertrochanteric Fractures Have Different Risk Factors: A Prospective Study 总被引:3,自引:0,他引:3
The aim of this study was to determine whether both types of hip fracture, femoral neck and intertrochanteric, have similar
risk factors. A prospective cohort study was carried out on community-dwelling elderly women in four areas of the United States:
Baltimore, MD; Pittsburgh, PA; Minneapolis, MN and Portland, OR. The participants were 9704 Caucasian women, 65 years and
older, of whom 279 had fractured their femoral neck and 222 had fractured their trochanteric region of the proximal femur.
The predictors used were the bone mass of the calcaneus and proximal femur, anthropometry, history of fracture (family and
personal), medication use, functional status, physical activity and visual function. The main outcome measures were femoral
neck and intertrochanteric fractures occurring during an average of 8 years of follow-up. In multivariate proportional hazards
models, several risk factors increased the risk of both types of hip fracture; including femoral neck bone density and increased
functional difficulty. In hazard regression models that directly compared risk factors for the two types of hip fracture,
calcaneal bone mineral density (BMD) predicted femoral neck fractures more strongly than intertrochanteric fractures (OR =
1.16; 95% CI = 1.02–1.31). Steroid use and impaired functional status also predicted femoral neck fractures instead of intertrochanteric
fractures. Poor health status (OR = 0.74; 95% CI = 0.55–1.00) predicted intertrochanteric fractures more strongly than femoral
neck fractures. We conclude that femoral neck fractures are largely predicted by BMD and poor functional ability while aging
and poor health status predispose to intertrochanteric fractures.
Received: 8 February 2000 / Accepted: 10 June 2000 相似文献
14.
A. Ekman K. Michaëlsson M. Petrén-Mallmin S. Ljunghall H. Mallmin 《Osteoporosis international》2001,12(3):185-191
Dual-energy X-ray absorptiometry (DXA) of the proximal femur and in more recent years quantitative ultrasound (QUS) of the
heel are the most established methods for assessing hip fracture risk. Measurement of the fingers offers a new approach. We
performed DXA of the proximal femur, QUS of the heel and fingers, and radiographic absorptiometry (RA) of the fingers in 87
non-institutionalized women, 65–85 years of age, with a first hip fracture and compared them with 195 randomly selected age-matched
controls. Bone mineral density (BMD) of the femoral neck and heel Stiffness Index were significantly lower among cases than
among controls (by 15% and 17%, respectively; p<0.0001), whereas no significant differences were found for finger measurements. When applying the WHO criterion of osteoporosis,
62–98% of the patients were classified as osteoporotic, compared with 19–85% of the controls, depending on method and site.
The risks of hip fracture, estimated as odds ratios for every 1 SD reduction in femoral neck BMD, heel Stiffness Index, finger
QUS and finger RA, were: 3.6 (95% CI 2.4–5.5), 3.4 (95% CI 2.2–5.0), 1.0 (95% CI 0.7–1.3) and 1.2 (95% CI 0.8–1.6), respectively.
Compared with women with normal BMD of the femoral neck, those classified as osteopenic had an odds ratio of hip fracture
of 14 (95% CI 2-110), whereas those classified as osteoporotic had an odds ratio of 63 (95% CI 8–501). We conclude that hip
DXA and heel QUS have similar capacities to discriminate the risk of a first hip fracture, whereas QUS and RA of the phalanges
seem inferior techniques for differentiating female hip fracture patients from controls.
Received: 10 March 2000 / Accepted: 21 September 2000 相似文献
15.
Femoral Bone Mineral Density, Neck-Shaft Angle and Mean Femoral Neck Width as Predictors of Hip Fracture in Men and Women 总被引:19,自引:6,他引:13
C. Gómez Alonso M. Díaz Curiel F. Hawkins Carranza R. Pérez Cano A. Díez Pérez 《Osteoporosis international》2000,11(8):714-720
The effect of femoral bone mineral density (BMD) and several parameters of femoral neck geometry (hip axis length, neck–shaft
angle and mean femoral neck width) on hip fracture risk in a Spanish population was assessed in a cross-sectional study. All
parameters were determined by dual-energy X-ray absorptiometry. There were 411 patients (116 men, 295 women; aged 60–90 years)
with hip fractures in whom measurements were taken in the contralateral hip. Controls were 545 persons (235 men, 310 women;
aged 60–90 years) who participated in a previous study on BMD in a healthy Spanish population. Femoral neck BMD was significantly
lower, and neck–shaft angle and mean femoral neck width significantly higher, in fracture cases than in controls. The logistic
regression analysis adjusted by age, height and weight showed that a decrease of 1 standard deviation (SD) in femoral neck
BMD was associated with an odds ratio of hip fracture of 4.52 [95% confidence interval (CI) 2.93 to 6.96] in men and 4.45
(95% CI 3.11 to 6.36) in women; an increase of 1 SD in neck–shaft angle of 2.45 (95% CI 1.73 to 3.45) in men and 3.48 (95%
CI 2.61 to 4.65) in women; and an increase of 1 SD in mean femoral neck width of 2.15 (95% CI 1.55 to 2.98) in men and 2.40
(95% CI 1.79 to 3.22) in women. The use of a combination of femoral BMD and geometric parameters of the femoral neck except
for hip axis length may improve hip fracture risk prediction allowing a better therapeutic strategy for hip fracture prevention.
Received: 16 September 1999 / Accepted: 22 February 2000 相似文献
16.
J. A. Langlois M. E. Mussolino M. Visser A. C. Looker T. Harris J. Madans 《Osteoporosis international》2001,12(9):763-768
Although weight loss increases bone loss and hip fracture risk in older women, little is known about the relation between
weight loss in middle-aged women and subsequent hip fracture risk. The objective of this study was to determine the association
between weight loss from reported maximum body weight in middle-aged and older women and the risk of hip fracture. Data were
from a nationally representative sample of 2180 community-dwelling white women aged 50–74 years from the Epidemiologic Follow-up
Study of the first National Health and Nutrition Examination Survey (NHEFS). In this prospective cohort study, incident hip
fracture was ascertained during 22 years of follow-up. The adjusted relative risks associated with weight loss of 10% or more
from maximum body weight were elevated for both middle-aged (RR 2.54; 95% CI 1.10–5.86) and older women (RR 2.04; 95% CI 1.37–3.04).
For both ages combined, women in the lowest tertile of body mass index at maximum who lost 10% or more of weight had the highest
risk of hip fracture (RR 2.37; 95% CI 1.32–4.27). Weight loss from maximum reported body weight in women aged 50–64 years
and 65–74 years increased their risk of hip fracture, especially among those who were relatively thin. Weight loss of 10%
or more from maximum weight among both middle-aged and older women is an important indicator of hip fracture risk.
Received: 13 August 1999 / Accepted: 26 April 2000 相似文献
17.
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
18.
Prevalent Vertebral Deformity Predicts Incident Hip though not distal Forearm Fracture: Results from the European Prospective Osteoporosis Study 总被引:5,自引:5,他引:5
A. A. Ismail W. Cockerill C. Cooper J. D. Finn K. Abendroth G. Parisi D. Banzer L. I. Benevolenskaya A. K. Bhalla J. Bruges Armas J. B. Cannata P. D. Delmas J. Dequeker G. Dilsen R. Eastell O. Ershova J. A. Falch B. Felsch S. Havelka K. Hoszowski I. Jajic U. Kragl O. Johnell A. Lopez Vaz R. Lorenc G. Lyritis F. Marchand P. Masaryk C. Matthis T. Miazgowski H. A. P. Pols G. Poor A. Rapado H. H. Raspe D. M. Reid W. Reisinger J. Janott C. Scheidt-Nave J Stepan C. Todd K. Weber A. D. Woolf G. Ambrecht W. Gowin D. Felsenberg M. Lunt J. A. Kanis J. Reeve A. J. Silman T. W. O’Neill 《Osteoporosis international》2001,12(2):85-90
The presence of a vertebral deformity increases the risk of subsequent spinal deformities. The aim of this analysis was to
determine whether the presence of vertebral deformity predicts incident hip and other limb fractures. Six thousand three hundred
and forty-four men and 6788 women aged 50 years and over were recruited from population registers in 31 European centers and
followed prospectively for a median of 3 years. All subjects had radiographs performed at baseline and the presence of vertebral
deformity was assessed using established morphometric methods. Incident limb fractures which occurred during the follow- up
period were ascertained by annual postal questionnaire and confirmed by radiographs, review of medical records and personal
interview. During a total of 40 348 person-years of follow-up, 138 men and 391 women sustained a limb fracture. Amongst the
women, after adjustment for age, prevalent vertebral deformity was a strong predictor of incident hip fracture, (rate ratio
(RR) = 4.5; 95% CI 2.1–9.4) and a weak predictor of ‘other’ limb fractures (RR = 1.6; 95% CI 1.1–2.4), though not distal forearm
fracture (RR = 1.0; 95% CI 0.6–1.6). The predictive risk increased with increasing number of prevalent deformities, particularly
for subsequent hip fracture: for two or more deformities, RR = 7.2 (95% CI 3.0–17.3). Amongst men, vertebral deformity was
not associated with an increased risk of incident limb fracture though there was a nonsignificant trend toward an increased
risk of hip fracture with increasing number of deformities. In summary, prevalent radiographic vertebral deformities in women
are a strong predictor of hip fracture, and to a lesser extent humerus and ‘other’ limb fractures; however, they do not predict
distal forearm fractures.
Received: 23 February 2000 / Accepted: 11 August 2000 相似文献
19.
Association Between Colles’ Fracture and Low Bone Mass: Age-Based Differences in Postmenopausal Women 总被引:3,自引:0,他引:3
E. Kanterewicz E. Kanterewicz A. Yañez A. Pérez-Pons I. Codony L. Del Rio A. Díez-Pérez 《Osteoporosis international》2002,13(10):824-828
Colles’ fracture (CF) in postmenopausal women has been linked to low bone mass at the lumbar spine and hip. However, the
diverse methodological approaches of previous studies make the results difficult to compare and thus the implications of CF
in osteoporosis daily clinical practice are not clear. We explored the association between CF and low bone mineral density
(BMD) in an incident case-control study in 58 postmenopausal Spanish women aged 45–80 years with recent CF and in 83 population-based
controls of the same age range. The BMD of ultradistal distal forearm, lumbar spine and hip was measured by dual-energy X-ray
absorptiometry (DXA) and WHO criteria were used to define osteoporosis and osteopenia. BMD was significantly lower in cases
for all three areas (p<0.001). Osteoporosis was more prevalent in cases than controls in the wrist (60% vs. 35%, p<0.001), lumbar spine (47% vs. 20%, p<0.005) and hip (19% vs. 6%, p<0.005). After adjusting for age, menopausal status and body mass index, osteoporosis and osteopenia remained significantly
associated with CF only in women aged 65 years or less (ultradistal forearm OR 5.7 (95% CI 1.2–27.2), lumbar spine OR 3.9
(95% CI 1.1–14.3)). We conclude that CF in postmenopausal women aged 65 or less may be used as a sentinel finding to identify
patients with generalized osteoporosis. Additionally, 70% of all CF patients regardless of their age had low bone mass (T-score<−1SD) in any studied site.
Received: 3 December 2001 / Accepted: 22 May 2002 相似文献
20.
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