RISK-FACTORS FOR HIP FRACTURE IN WHITE WOMEN
RISK-FACTORS FOR HIP FRACTURE IN WHITE WOMEN
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DOI：
10.1056/nejm199503233321202
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发表时间：
1995-03-23
影响因子：
158.5
通讯作者：
VOGT, TM
中科院分区：
文献类型：
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作者：
CUMMINGS, SR;NEVITT, MC;VOGT, TM
背景髋部骨折的许多危险因素已被提出，但尚未在一项全面的前瞻性研究中进行评估。我们评估了9516名年龄在65岁或65岁以上、既往无髋部骨折的白色女性的潜在危险因素，包括骨量。然后，我们每隔4个月对这些妇女进行平均4.1年的随访，以确定髋部骨折的频率。所有髋关节骨折的报告均通过回顾X线片进行验证。在随访期间，192名女性首次髋部骨折不是由于机动车事故。在多变量年龄调整分析中，母亲髋部骨折史使髋部骨折的风险增加一倍（相对风险为2.0; 95%置信区间为1.4 - 2.9），在调整骨密度后，风险的增加仍然显着。从25岁开始体重增加的女性风险较低。在50岁以后曾有过任何类型骨折的女性中，25岁时身高较高，认为自己的健康状况一般或较差，曾患有甲状腺功能亢进症，曾接受过长效苯二氮卓类药物或抗惊厥药物治疗，摄入大量咖啡因，或每天站立4小时或更少的女性中，风险更高。与增加的风险相关的检查结果包括不能从椅子上站起来而不使用手臂，深度知觉差，对比敏感度差和休息时心动过速。跟骨骨密度低也是一个独立的危险因素。髋部骨折的发生率为1.1（95%置信区间，0.5 - 1.6）每1000名妇女-年，在年龄至27岁的跟骨骨密度正常且风险因素不超过两个的妇女中（95%置信区间，20 - 34）/1000妇女年，在那些有五个或更多危险因素的妇女中，骨密度在她们年龄的最低三分之一。具有多种危险因素和低骨密度的妇女髋部骨折的风险特别高。保持体重，步行锻炼，避免长效苯二氮卓类药物，尽量减少咖啡因摄入，以及治疗视觉功能受损，这些都是可能降低风险的步骤。
Background. Many risk factors for hip fractures have been suggested but have not been evaluated in a comprehensive prospective study.Methods. We assessed potential risk factors, including bone mass, in 9516 white women 65 years of age or older who had had no previous hip fracture. We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture. All reports of hip fractures were validated by review of x-ray films.Results. During the follow-up period, 192 women had first hip fractures not due to motor vehicle accidents. In multivariable age-adjusted analyses, a maternal history of hip fracture doubled the risk of hip fracture (relative risk, 2.0; 95 percent confidence interval, 1.4 to 2.9), and the increase in risk remained significant after adjustment for bone density. Women who had gained weight since the age of 25 had a lower risk. The risk was higher among women who had previous fractures of any type after the age of 50, were tall at the age of 25, rated their own health as fair or poor, had previous hyperthyroidism, had been treated with long-acting benzodiazepines or anticonvulsant drugs, ingested greater amounts of caffeine, or spent four hours a day or less on their feet. Examination findings associated with an increased risk included the inability to rise from a chair without using one's arms, poor depth perception, poor contrast sensitivity, and tachycardia at rest. Low calcaneal bone density was also an independent risk factor. The incidence of hip fracture ranged from 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 (95 percent confidence interval, 20 to 34) per 1000 woman-years among those with five or more risk factors and bone density in the lowest third for their age.Conclusions. Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are among the steps that may decrease the risk.