In elderly men and women treated for osteoporosis a low creatinine clearance of <65 ml/min is a risk factor for falls and fractures
In elderly men and women treated for osteoporosis a low creatinine clearance of <65 ml/min is a risk factor for falls and fractures
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DOI：
10.1007/s00198-005-1903-7
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发表时间：
2005-12-01
影响因子：
4
通讯作者：
Stähelin, HB
中科院分区：
文献类型：
--
作者：
Dukas, L;Schacht, E;Stähelin, HB
最近，< 65 ml/min的低肌酐清除率（CrCl）被认为是社区居住老年人跌倒和跌倒数量的一个新的重要和独立的危险因素。在这项研究中，我们调查了低肌酐清除率< 65 ml/min是否是骨质疏松治疗的老年男性和女性跌倒和骨折的危险因素。在一项横断面研究中，我们通过问卷调查评估了5313名接受骨质疏松症治疗的德国男性和女性在过去12个月内经历过跌倒的患病率。CrCl采用已建立的Cockcroft-Gault公式计算。根据CrCl截断值为65 ml/min，在多变量控制的logistic回归模型中评估跌倒和骨折的发生率。P值是双面的。在这项研究中，接受骨质疏松治疗的老年男性和女性（n = 5,313）， 60.9% （n = 3,238）的CrCl为>= 65 ml/min，这在多变量对照分析中与CrCl为>= 65 ml/min （n = 2,075）相关，发生跌倒的风险显著增加（1,775/3,238比773/2,075,OR 1.69, 95% CI 1.50-1.91, P < 0.0001），多次跌倒的风险增加（37.1比22.6%,OR 1.63, 95% CI 1.42-1.87, P < 0.0001）。此外，与肌酐清除率< 65 ml/min相比，肌酐清除率< 65 ml/min也与髋部骨折（OR 1.57, 95% CI 1.18-2.09, P = 0.002）、桡骨骨折（OR 1.79, 95% CI 1.39-2.31, P = < 0.0001）、全椎体骨折（OR 1.31, 95% CI 1.19-1.55, P = 0.003）和跌倒相关椎体骨折（OR 1.24, 95% CI 1.03-1.54, P = 0.031）的多因素控制风险显著增加相关。与居住在社区的老年人类似，在接受骨质疏松治疗的老年男性和女性中，CrCl低于65 ml/min是发生跌倒的重要独立危险因素。此外，我们可以首次证明，在骨质疏松症治疗的老年男性和女性中，低肌酐清除率也与椎体、髋关节和桡骨骨折的风险显著增加有关。
Recently, a low creatinine clearance (CrCl) of < 65 ml/min was described as a new significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population. In this study we investigated if a low creatinine clearance of < 65 ml/min is also a risk factor for falls and fractures in elderly men and women treated for osteoporosis. In a cross-sectional study with the help of questionnaires we assessed the prevalence of having experienced falls within the last 12 months according to renal function in 5,313 German men and women receiving treatment for osteoporosis. The CrCl was calculated using the established Cockcroft-Gault formula. The prevalence of falls and fractures was assessed in multivariate-controlled logistic regression models according to a CrCl cut off of 65 ml/min. The P -values were two-sided. In this study of elderly men and women treated for osteoporosis (n = 5,313), 60.9% (n = 3,238) had a CrCl of >= 65 ml/min, which was associated in multivariate controlled analyses, compared to a CrCl of >= 65 ml/min (n = 2,075), with a significant increased risk of experiencing falls (1,775/3,238 vs. 773/2,075, OR 1.69, 95% CI 1.50-1.91, P < 0.0001) and an increased risk for multiple falls (37.1 vs. 22.6%, OR 1.63, 95% CI 1.42-1.87, P < 0.0001). Furthermore, compared to a creatinine clearance of < 65 ml/min, a creatinine clearance of < 65 ml/min was also associated with a significant increased multivariate controlled risk for hip fractures (OR 1.57, 95% CI 1.18-2.09, P = 0.002), for radial fractures (OR 1.79, 95% CI 1.39-2.31, P = < 0.0001), for total vertebral fractures (OR 1.31, 95% CI 1.19-1.55, P = 0.003) and for fall-associated vertebral fractures (OR 1.24, 95% CI 1.03-1.54, P = 0.031). Similar to community-dwelling elderly, in elderly men and women treated for osteoporosis a CrCl of less than 65 ml/min is a significant and independent risk factor for falls. Furthermore, we could show for the first time that a low creatinine clearance in elderly men and women treated for osteoporosis is also associated with a significantly increased risk of vertebral, hip and radial fractures.