中老年妇女骨折后再骨折的观察

Recurrent fracture in aged women

目的 探讨中老年妇女骨折后再骨折发生情况及防治策略。方法 1997年 1月至 2 0 0 3年 11月随访 5 99例骨折的中老年妇女 ,统计其骨折发生时的年龄、骨折部位及双能X线下测定其腰椎及髋部的骨密度 ,了解其再骨折的情况。结果 初次骨折时桡骨骨折、肱骨近端骨折、脊柱骨折组的年龄差异无显著性 ,而髋部骨折的年龄较其他组的差异有显著性。初次桡骨骨折时骨密度可不下降 ,而肱骨近端骨折、腰椎骨折、髋部骨折时骨量减少 ;肱骨近端骨折、腰椎骨折、髋部骨折患者的骨密度与桡骨骨折患者的骨密度比较差异有显著性 (P <0 . 0 1) ;再次骨折发生率为 15 . 9% ,以髋部骨折组发生率为最高 2 1. 2 1% ,各组骨密度均有下降 ,尤其髋部骨折组发生再骨折时伴有严重的骨质疏松。结论中老年妇女初次骨折是一个重要的风险预测因素 ,初次桡骨骨折后应定期复查骨密度等 ,进行骨质疏松的预防 ;肱骨近端、腰椎、髋部初次骨折发生后在积极治疗骨折的同时应进行骨质疏松的药物治疗 ,并防止跌倒 ,以防再发生骨折。

Objective To evaluate incidence of refracture and recommend strategies of prevention and treatment in aged women with previous fracture. Methods 599 aged women with previous fracture were followedup between January 1997 and November 2003. The incidence of refracture was studied with regard to fracture site, age and bone mineral density (BMD). BMD was measured by dual energy X-ray absorptiometry. Results There was no significant difference in age between groups with radial fracture, proximal humeral fracture and spinal fracture, whereas the patients with hip fracture were older than others. The BMD might not decrease in group with radial fracture for the first time, but that in the other groups decreased signiticantly. The mean incidence of refracture was 15.9%, and in hip fracture group, it was 21.21%, the highest among all groups. BMD decreased in each refracture group. Conclusions Previous fracture is a high risk factor for refracture in aged women. These women must be followedup. Drugs should be given to prevent and treat osteoporosis, and falls must be prevented.