Determinants of Recovery Following Hip Fracture

髋部骨折是一个重大的公共卫生问题。我们之前的研究结果表明，在髋部骨折后的一年内，股骨颈骨密度（BMD）损失4.6%；骨密度的急剧下降伴随着骨代谢标志物的显著变化。拟议的辅助研究的母项目是一项随机对照试验，旨在减少髋部骨折后骨密度、肌肉和功能的损失。拟议的辅助研究将评估参与该干预研究的髋部骨折患者的骨代谢标志物和选定的调节激素，以便更好地了解运动在髋部骨折后一年影响骨骼健康的机制。这些标志物和激素也将在一组匹配的非骨折对照组中进行为期一年的评估，以确定骨密度低的虚弱老年人中骨代谢标志物的预期水平和变化。拟议研究的主要目的是：1)通过比较随机分配到家庭运动干预组和常规护理组患者髋部骨折后一年内的骨代谢，评估运动对髋部骨折后骨代谢的作用；2)通过比较常规护理组髋部骨折患者的骨代谢与匹配组非骨折对照组的骨代谢，将髋部骨折对骨代谢的影响与低骨密度相似人群的骨代谢的影响分开。这些问题将通过170名年龄在65岁以上的女性髋部骨折患者（100名纳入母研究，另外70名髋部骨折患者将纳入本辅助研究）和85名年龄和活动能力匹配、骨密度小于0.82g/cm2的非骨折对照组的数据来解决。患者随机接受为期一年的家庭锻炼计划，在急性治疗结束或常规护理后开始。作为母体研究的一部分，100名患者在住院期间进行了骨密度测量，并在2个月、6个月和12个月时再次进行了测量，这100名患者的血液样本被采集、处理和储存。对于辅助研究，该方案将扩展到包括70名额外的髋部骨折患者和85名非骨折对照组，后者将在入组时和12个月后进行测量。在这项辅助研究中，所有的血液样本（即在母体研究中收集的100名患者的血样，以及在辅助研究中收集的70名患者和85名非骨折对照者的血样）将被检测以确定四种骨代谢标志物和三种调节激素的水平。这种类型的信息将有助于制定干预措施，以改善骨骼健康和最大限度地恢复。

Hip fracture is a major public health problem. Results from our previous work demonstrate a 4.6 percent loss of femoral neck bone mineral density (BMD) during the year following a hip fracture; this dramatic loss in BMD is accompanied by notable changes in markers of bone metabolism. The parent project to the proposed ancillary study is a randomized controlled trial of a home-based exercise program intended to minimize losses in BMD, muscle and function following a hip fracture. The proposed ancillary study will evaluate markers of bone metabolism and selected regulating hormones in hip fracture patients who are participating in this intervention study in order to gain a better understanding of the mechanism by which exercise affects bone health during the year following a hip fracture. These markers and hormones also will be evaluated over a one year period in a matched group of non-fracture controls to establish expected levels and changes in markers of bone metabolism among a frail group of older persons who also have low BMD. The primary aims of the proposed study are: 1) to evaluate the role of exercise on bone metabolism following hip fracture by comparing bone metabolism during the year after hip fracture in patients randomized to a home-based exercise intervention with patients assigned to usual care, and 2) to separate the effects of hip fracture on bone metabolism from those of aging in similar persons with low BMD by comparing bone metabolism in hip fracture patients receiving usual care with bone metabolism in a matched group of non-fracture controls. These issues will be addressed using data from 170 female hip fracture patients age 65 plus (100 enrolled in the parent study, and an additional 70 hip fracture patients to be recruited for this ancillary study), and 85 age- and mobility-matched non- fracture controls with BMD Less than 0.82g/cm2. Patients are randomized to a year-long, home-based exercise program to begin when post-acute therapy ends, or usual care. As part of the parent study, 100 patients are having BMD measured during their hospital stay, and again at 2, 6, and 12 months, and blood samples for these 100 patients are being taken, processed, and stored. For the ancillary study, this protocol will be extended to include 70 additional hip fracture patients and 85 non- fracture controls, the latter of which will be measured at point of enrollment and 12 months later. For this ancillary study, all blood samples (i.e., those collected on 100 patients in the parent study and those collected on 70 patients and 85 non- fracture controls in the ancillary study) will be assayed to determine levels of four markers of bone metabolism and three regulating hormones. Information of this type will be useful developing interventions to improve bone health and maximize recovery.