Fall-related factors and risk of hip fracture: The EPIDOS prospective study
Fall-related factors and risk of hip fracture: The EPIDOS prospective study
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DOI：
10.1016/s0140-6736(96)01440-7
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发表时间：
1996-07-20
期刊：
影响因子：
168.9
通讯作者：
Breart, G
中科院分区：
文献类型：
--
作者：
DargentMolina, P;Favier, F;Breart, G
背景：大多数髋部骨折是由跌倒引起的。然而，与跌倒相关的因素的作用很少被研究。比较这些因素与骨密度（BMD）的预测价值对髋部骨折的预防具有重要意义。方法：我们在法国的5个中心招募了7575名年龄在75岁及以上、无髋部骨折史的女性，通过双光子x射线吸收仪和潜在的跌倒相关危险因素评估股骨颈骨密度，包括自我报告的身体能力、神经肌肉功能、活动能力、视觉功能和药物使用情况。我们每4个月对这些女性进行随访，记录髋部骨折事件。在平均1.9年的随访中，154名女性首次髋部骨折。在年龄调整的多变量分析中，我们发现了四个独立的与跌倒相关的髋部骨折预测因素：步态速度较慢（相对风险=1.4，每降低1个标准差[95% CI 1.1-1.6]）；完成串联（脚跟到脚趾）行走的难度（难度评分[1.0-1.5]为1分，1.2分）；视力下降（视力低于或等于2/10[1.1-3.7]为20）；小腿围小（1.5[1.0-2.2]）。在调整股骨颈骨密度后，神经肌肉损伤——步态速度、串联行走和视力低下仍然与随后髋部骨折的风险增加显著相关。高风险被定义为最高四分之一的风险，在基于高跌倒风险状态和低骨密度分类为高风险的女性中，髋部骨折的发生率为每1000名女性年29人，而在基于高跌倒风险状态或低骨密度分类为高风险的女性中，髋部骨折的发生率为每1000名女性年11人；根据这两项标准被列为低风险的妇女的死亡率为千分之五。我们得出结论，神经肌肉和视觉障碍以及股骨颈骨密度是老年流动女性髋部骨折风险的重要且独立的预测因素，并且它们的综合评估提高了髋部骨折的预测。
Background Most hip fractures result from falls. However, the role of fall-related factors has seldom been examined. Comparison of the predictive value of these factors with that of bone mineral density (BMD) has important implications for the prevention of hip fractures.Methods We assessed femoral-neck BMD by dual-photon X-ray absorptiometry and potential fall-related risk factors, which included self-reported physical capacity, neuromuscular function, mobility, visual function, and use of medication in 7575 women, aged 75 years or older, with no history of hip fracture recruited at five centres in France. We followed up these women every 4 months to record incident hip fractures. During an average of 1.9 years of follow-up, 154 women suffered a first hip fracture.Findings In age-adjusted multivariate analyses, we found four independent fall-related predictors of hip fracture: slower gait speed (relative risk=1.4 for 1 SD decrease [95% CI 1.1-1.6]); difficulty in doing a tandem (heel-to-toe) walk (1.2 for 1 point on the difficulty score [1.0-1.5]); reduced visual acuity (20 for acuity less than or equal to 2/10 [1.1-3.7]); and small calf circumference (1.5 [1.0-2.2]). After adjustment for femoral-neck BMD, neuromuscular impairment-gait speed, tandem walk-and poor vision remained significantly associated with an increased risk of subsequent hip fracture. With high risk defined as the top quartile of risk, the rate of hip fracture among women classified as high risk based on both a high fall-risk status and low BMD was 29 per 1000 woman-years, compared with 11 per 1000 for women classified as high risk by either a high fall-risk status or low BMD; for women classified as low risk based on both criteria the rate was five per 1000.Interpretation We conclude that neuromuscular and visual impairments, as well as femoral-neck BMD, are significant and independent predictors of the risk of hip fracture in elderly mobile women, and that their combined assessment improves the prediction of hip fractures.