上海地区绝经后女性患者脆性骨折危险因素的回顾性病例研究

目的调查绝经后女性患者在就诊后10年期间的脆性骨折的发生率,并分析其危险因素。方法以2008年11月-2010年11月就诊于华东医院的947例45~84岁绝经后女性为研究对象,于基线水平调查研究对象的一般情况、骨折史、慢性疾病史等,并用双能X射线(DXA)检测患者腰椎、股骨颈、髋部的骨密度。于2019年11月对患者进行电话随访,记录患者随访期间发生的骨质疏松性骨折的部位和次数,采用Logistic回归分析骨质疏松性骨折的危险因素。结果(1)本研究基线时筛选1100例,最终947例患者完成研究,入组时平均年龄为(63.6±9.3)岁。在平均10年的随访期间,共有10.3%的女性发生了骨质疏松性骨折。在入组时年龄段为45~54岁,55~64岁,65~74岁,75~84岁的患者,在随访期间的脆性骨折发生率分别为7.4%,11.1%,12.9%和7.5%。(2)随访期间最常见的骨折部位为椎体骨折,涉及4.5%的患者,前臂、髋部、肱骨部位的骨折分别为1.4%,0.8%和0.4%。(3)Logistic回归分析显示:脆性骨折史、慢性阻塞性肺病、长期激素使用史以及腰椎低骨量是随访期间老年女性骨质疏松性骨折的危险因素。结论(1)椎体骨折是老年女性患者最常见的脆性骨折类型。(2)除腰椎低骨量外,脆性骨折史、慢性阻塞性肺病、长期使用激素可增加脆性骨折风险,需给予重视。

Study of risk factors of fragility fractures in postmenopausal women in Shanghai

Objective To investigate the incidence of fragility fractures in postmenopausal female patients during the 10-year period after visiting the doctor,and analyze the risk factors.Methods A total of 947 postmenopausal women over 45 years old who visited Huadong Hospital from November 2008 to November 2010 were enrolled.The general condition,fracture history and chronic disease history of the subjects were investigated at the baseline level,and the bone mineral density of lumbar spine,femoral neck and hip were detected by dual energy X-ray(DXA).The telephone interviews with the patients were conducted in November 2019,and the location and number of fragility fractures that occurred during the 10 years followup were recorded.Logistic regression was used to analyze the risk factors of fragility fracture.Results(1)1100 patients were screened at baseline and 947 of them completed the study.The average age of 947 patients at the time of enrollment was(63.6±9.3)years.During an average follow-up period of 10 years,10.3%of subjects developed osteoporotic fractures.The incidence of fragility fracture was 7.4%,11.1%,12.9%and 7.5%in patients aged 45-54 years,55-64 years,65-74 years and 75-84 years at the time of enrollment,respectively.(2)During the follow-up period,the most common fracture location was vertebral body fracture,involving 4.5%of the patients.The fractures of forearm,hip and humerus accounted for 1.4%,0.8%and 0.4%,respectively.(3)Logistic regression analysis showed that fragility fracture history,chronic obstructive pulmonary disease,long-term hormone use history,and low lumbar bone mass were risk factors for fragility fractures in elderly women during follow-up.Conclusion(1)Vertebral fracture is the most common type of fragility fracture in elderly women.(2)In addition to low lumbar bone mass,history of fragility fracture,chronic obstructive pulmonary disease and long-term use of hormone can increase the risk of fragility fracture.It is necessary to pay attention to the identification of these risk factors.