Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer's disease - exposure-matched cohort study
Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer's disease - exposure-matched cohort study
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DOI：
10.1186/s12877-016-0383-2
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发表时间：
2016-12-01
期刊：
影响因子：
4.1
通讯作者：
Hartikainen, Sirpa
中科院分区：
文献类型：
--
作者：
Tolppanen, Anna-Maija;Taipale, Heidi;Hartikainen, Sirpa
背景资料：痴呆症，阿尔茨海默氏病（AD）是最常见的形式，是一个主要的髋部骨折的危险因素，但目前还不知道是否有相同的因素预测髋部骨折的人和没有痴呆症/AD。我们比较了AD患者和非AD患者髋部骨折和髋部骨折后死亡率的预测因素。一个由芬兰所有社区居民组成的确定性匹配队列，他们在2005 - 2011年接受了新的临床验证的AD诊断，并且没有既往髋部骨折史（N = 67，072），以及一个年龄、性别和地区匹配的无AD人群队列（N = 67，072）。采用考克斯回归分析评估了社会人口学特征、合并症和药物治疗与髋部骨折风险和髋部骨折后死亡率之间的关系。正如预期的那样，2005 - 2012年髋部骨折的发病率（2.19/100人-年vs非AD队列0.90/100人-年），以及髋部骨折后的死亡率（29/100人-年vs非AD队列中的23/100人-年）在AD队列中更高。无论风险因素如何，这种差异都是明显的。精神和行为障碍（校正的风险比; HR 95%置信区间CI：AD和非AD队列分别为1.16、1.09 - 1.24和1.71、1.52 - 1.92），抗精神病药（AD和非AD队列分别为1.12、1.04 - 1.20和1.56、1.38 - 1.76）和抗抑郁药（AD和非AD队列分别为1.06、1.00 - 1.12和1.34 1.22 - 1.47）与较高的雌激素/联合激素治疗相关（AD和非AD队列分别为0.87、0.77 - 0.9和0.79、0.64 - 0.98），以降低两个队列中的髋部骨折风险。中风（1.42，1.26 - 1.62），糖尿病（1.13，0.99 - 1.28），积极的癌症治疗（1.67，1.22 - 2.30），质子泵抑制剂（1.14，1.05 - 1.25）、抗癫痫药（1.27，1.11 - 1.46）和阿片类药物（1.10，1.01 - 1.19）与非AD队列中较高的髋部骨折风险相关。同样，死亡风险因素（年龄，性别，几个合并症和药物治疗）之间的关联更强的non-AD cohol.Conclusions：AD本身似乎是这样一个显着的危险因素髋部骨折，髋部骨折后的死亡率，它推翻或减少其他危险因素的影响。因此，重要的是要制定和实施预防干预措施，是适当的和有效的，在这一人群。
Background: Dementia, with Alzheimer's disease (AD) being the most common form, is a major hip fracture risk factor, but currently it is not known whether the same factors predict hip fracture among persons with and without dementia/AD. We compared the predictors of hip fracture and mortality after hip fracture in persons with and without AD.Methods: An exposure-matched cohort of all community-dwellers of Finland who received a new clinically verified AD diagnosis in 2005-2011 and had no history of previous hip fracture (N = 67,072) and an age, sex, and region-matched cohort of persons without AD (N = 67,072). Associations between sociodemographic characteristics, comorbidities and medications and risk of hip fracture and mortality after hip fracture were assessed with Cox regression.Results: As expected, the incidence of hip fractures in 2005-2012 (2.19/100 person-years vs 0.90/100 person-years in the non-AD cohort), as well as mortality after hip fracture (29/100 person-years vs 23/100 person-years in the non-AD cohort) were higher in the AD cohort. This difference was evident regardless of the risk factors. Mental and behavioural disorders (adjusted hazard ratio; HR 95% confidence interval CI: 1.16, 1.09-1.24 and 1.71, 1.52-1.92 in the AD and non-AD-cohorts), antipsychotics (1.12, 1.04-1.20 and 1.56, 1.38-1.76 for AD and non-AD-cohorts) and antidepressants (1.06, 1.00-1.12 and 1.34 1.22-1.47 for AD and non-AD-cohorts) were related to higher, and estrogen/combination hormone therapy (0.87, 0.77-0.9 and 0.79, 0.64-0.98 for AD and non-AD-cohorts) to lower hip fracture risk in both cohorts. Stroke (1.42, 1.26-1.62), diabetes (1.13, 0.99-1.28), active cancer treatment (1.67, 1.22-2.30), proton pump inhibitors (1.14, 1.05-1.25), antiepileptics (1.27, 1.11-1.46) and opioids (1.10, 1.01-1.19) were associated with higher hip fracture risk in the non-AD cohort. Similarly, the associations between mortality risk factors (age, sex, several comorbidities and medications) were stronger in the non-AD cohort.Conclusions: AD itself appears to be such a significant risk factor for hip fracture, and mortality after hip fracture, that it overrules or diminishes the effect of other risk factors. Thus, it is important to develop and implement preventive interventions that are suitable and effective in this population.