Risk factors for hip fracture in men from Southern Europe: The MEDOS study
Risk factors for hip fracture in men from Southern Europe: The MEDOS study
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DOI：
10.1007/s001980050115
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发表时间：
1999-01-01
影响因子：
4
通讯作者：
Ribot, C
中科院分区：
文献类型：
--
作者：
Kanis, J;Johnell, O;Ribot, C
本研究的目的是确定50岁以上男性髋部骨折的危险因素。在一项髋部骨折发病率的前瞻性研究中，我们从葡萄牙、西班牙、法国、意大利、希腊和土耳其的14个中心确定了730名髋部骨折男性，并从社区或人口登记中选择了1132名年龄分层对照。问卷调查了工作、过去和现在的体力活动、疾病和药物、身高、体重、共病指数以及烟草、酒精、钙、咖啡和茶的消费等方面。通过单变量分析确定的显著风险因素包括低体重指数（BMI）、低阳光照射、低程度的娱乐性体力活动、低牛奶和奶酪消费量以及精神评分差。合并症包括睡眠障碍、体重减轻、精神状态受损和食欲不振也是重要的风险因素。既往卒中伴偏瘫、既往脆性骨折、老年痴呆、酗酒和胃切除术与显著风险相关，而骨关节病、肾结石和心肌梗死与较低风险相关。服用药物与风险差异无关，除了使用镇痛药的保护作用与共存的骨关节病无关，以及使用抗癫痫药的风险增加。在潜在的“可逆”风险因素中，BMI，休闲运动，阳光照射和茶，酒精和烟草的消费在多变量分析后仍然是独立的风险因素，占髋部骨折的54%。排除BMI，46%的骨折可以根据所寻求的风险因素来解释。在其余因素中，阳光照射不足和体力活动减少是最高的归因风险（分别为14%和9%）。使用危险因素预测髋部骨折的敏感性和特异性相对较低（分别为59.6%和61.0%）。我们的结论是生活方式因素与髋部骨折风险的显著差异有关。潜在的补救因素，包括低程度的体育锻炼和低BMI占总风险的很大一部分。
The aims of this study were to identify risk factors for hip fracture in men aged 50 years or more. We identified 730 men with hip fracture from 14 centers from Portugal, Spain, France, Italy, Greece and Turkey during the course of a prospective study of hip fracture incidence and 1132 age-stratified controls selected from the neighborhood or population registers. The questionnaire examined aspects of work, physical activity past and present, diseases and drugs, height, weight, indices of co-morbidity and consumption of tobacco, alcohol, calcium, coffee and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), low sunlight exposure, a low degree of recreational physical activity, low consumption of milk and cheese, and a poor mental score. Co-morbidity including sleep disturbances, loss of weight, impaired mental status and poor appetite were also significant risk factors. Previous stroke with hemiplegia, prior fragility fractures, senile dementia, alcoholism and,gastrectomy were associated with significant risk, whereas osteoarthrosis, nephrolithiasis and myocardial infarction were associated with lower risks. Taking medications was not associated with a difference in risk apart from a protective effect with the use of analgesics independent of co-existing osteoarthrosis and an increased risk with the use of antiepileptic agents. Of the potentially 'reversible' risk factors, BMI, leisure exercise, exposure to sunlight and consumption of tea and alcohol and tobacco remained independent risk factors after multivariate analysis, accounting for 54% of hip fractures. Excluding BMI, 46% of fractures could be explained on the basis of the risk factors sought. Of the remaining factors low exposure to sunlight and decreased physical activity accounted for the highest attributable risks (14% and 9% respectively). The use of risk factors to predict hip fractures had relatively low sensitivity and specificity (59.6% and 61.0% respectively). We conclude that lifestyle factors are associated with significant differences in the risk of hip fracture. Potentially remediable factors including a low degree of physical exercise and a low BMI account for a large component of the total risk.