Determinants of Recovery Following Hip Fracture

髋部骨折是一个主要的公共卫生问题。我们先前工作的结果显示，在髋部骨折后的一年中，股骨颈骨密度(BMD)损失了4.6%；这种急剧的BMD损失伴随着骨代谢标记物的显著变化。拟议的辅助研究的父项目是一项以家庭为基础的锻炼计划的随机对照试验，旨在将髋部骨折后骨密度、肌肉和功能的损失降至最低。这项拟议的辅助研究将评估参与这项干预研究的髋部骨折患者的骨代谢标记物和选定的调节激素，以更好地了解髋部骨折后一年内运动影响骨骼健康的机制。这些标记物和激素还将在一组匹配的非骨折对照组中进行为期一年的评估，以确定在同样具有低骨密度的虚弱老年人组中骨代谢标记物的预期水平和变化。这项拟议研究的主要目的是：1)通过比较随机接受家庭运动干预的患者和分配给常规护理的患者在髋部骨折后一年内的骨代谢，来评估运动对髋部骨折后骨代谢的作用；以及2)通过比较接受常规护理的髋部骨折患者和匹配的非骨折对照组的骨代谢，区分髋部骨折对骨代谢的影响和类似低骨密度患者的衰老影响。这些问题将使用170名年龄在65岁以上的女性髋部骨折患者(100名在母研究中登记，另外70名髋部骨折患者将被招募到这项辅助研究中)和85名年龄和活动能力匹配的非骨折对照组的骨密度低于0.82g/cm2的数据来解决。患者被随机分配到为期一年的家庭锻炼计划，当急性后治疗结束时开始，或常规护理。作为家长研究的一部分，100名患者在住院期间以及在2、6和12个月时进行了骨密度测量，并对这100名患者的血液样本进行了采集、处理和存储。对于辅助研究，这一方案将扩展到包括另外70名髋部骨折患者和85名非骨折对照组，后者将在入选时和12个月后进行测量。在这项辅助研究中，所有的血液样本(即在母研究中收集的100名患者的血液样本，以及辅助研究中的70名患者和85名非骨折对照组的血液样本)都将被检测，以确定四种骨代谢标志物和三种调节激素的水平。这种类型的信息将是开发干预措施以改善骨骼健康和最大限度恢复的有用信息。

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.