Osteoporotic fractures and hospitalization risk in chronic spinal cord injury
Osteoporotic fractures and hospitalization risk in chronic spinal cord injury
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DOI：
10.1007/s00198-008-0671-6
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发表时间：
2009-03-01
影响因子：
4
通讯作者：
Garshick, E.
中科院分区：
文献类型：
--
作者：
Morse, L. R.;Battaglino, R. A.;Garshick, E.
骨质疏松是公认的脊髓损伤的并发症。我们报告运动性完全性脊髓损伤和损伤后饮酒是骨折住院治疗的危险因素。临床评估没有包括骨质疏松症的诊断和治疗考虑，表明需要改进临床方案。骨质疏松性长骨骨折的治疗通常会导致患有脊髓损伤的个人住院时间较长。临床特征和导致住院风险的因素以前没有被描述过。315名退伍军人在脊髓损伤后1年完成了健康问卷，并在研究开始时接受了临床检查。采用考虑重复事件的多因素COX回归分析1996年至2003年退伍军人事务医疗中心骨折相关住院的纵向预测因素。315名研究对象中有1000 487人住院，其中39人因骨折治疗住院(2.6%)。中位住院时间为35天。与骨折相关的并发症发生率为53%。入院的独立危险因素是运动完全性脊髓损伤和运动不完全性脊髓损伤(危险比=3.73，95%CI=1.46~10.50)。随着受伤后饮酒量的增加，患病风险呈显著的线性趋势。记录回顾表明，在这些入院期间没有得到骨质疏松症的评估。前瞻性评估，退伍军人事务医学中心因低冲击性骨折而住院的情况在运动性完全性脊髓损伤中更为常见，并与损伤后更多的酒精使用有关。骨质疏松症的诊断和治疗考虑不是临床评估的一部分，这表明需要改进方案，以防止低冲击性骨折和相关入院。
Osteoporosis is a well acknowledged complication of spinal cord injury. We report that motor complete spinal cord injury and post-injury alcohol consumption are risk factors for hospitalization for fracture treatment. The clinical assessment did not include osteoporosis diagnosis and treatment considerations, indicating a need for improved clinical protocols.Treatment of osteoporotic long bone fractures often results in lengthy hospitalizations for individuals with spinal cord injury. Clinical features and factors that contribute to hospitalization risk have not previously been described.Three hundred and fifteen veterans a parts per thousand yen 1 year after spinal cord injury completed a health questionnaire and underwent clinical exam at study entry. Multivariate Cox regression accounting for repeated events was used to assess longitudinal predictors of fracture-related hospitalizations in Veterans Affairs Medical Centers 1996-2003.One thousand four hundred and eighty-seven hospital admissions occurred among 315 participants, and 39 hospitalizations (2.6%) were for fracture treatment. Median length of stay was 35 days. Fracture-related complications occurred in 53%. Independent risk factors for admission were motor complete versus motor incomplete spinal cord injury (hazard ratio = 3.73, 95% CI = 1.46-10.50). There was a significant linear trend in risk with greater alcohol consumption after injury. Record review indicated that evaluation for osteoporosis was not obtained during these admissions.Assessed prospectively, hospitalization in Veterans Affairs Medical Centers for low-impact fractures is more common in motor complete spinal cord injury and is associated with greater alcohol use after injury. Osteoporosis diagnosis and treatment considerations were not part of a clinical assessment, indicating the need for improved protocols that might prevent low-impact fractures and related admissions.