跌倒与骨质疏松性骨折

Fall and osteoporotic fractures

老年人的跌倒是内在因素与外在因素共同作用的结果。跌倒是衰老的标志之一,发生率甚高。跌倒的低能量损伤造成的后果往往是骨质疏松性骨折(脆性骨折)。脆性骨折是骨结构衰退和骨功能衰竭的表现。老年人的健康状况、并存的慢性疾病、遗传因素、步态失控、精神与心理状态、药物应用、行为习惯、生活环境等都是导致跌倒的危险因素。约9%的跌倒老年人会发生骨折,除了外在的损伤应力外,骨骼本身的因素如骨量与骨质量降低和机械强度的减弱在骨折发生中均起重要作用。影响骨量和骨质量的疾病、药物、身高与体重指数(BMI)、营养状态、性腺功能、维生素D的摄入以及既往骨折史等都是预测骨折风险的重要因素。目前应用较广的预测跌倒与脆性骨折风险的方法是世界卫生组织(WHO)推荐的FRAX方法。危险因素分析有助于发现跌倒和骨质疏松骨折的老年高危人群。对高危人群监护、预防干预是降低跌倒发生及骨折风险的有效途径。提高对高危个体的危险因素分析、制定个体化的预防干预措施有望达到有效降低老年人跌倒与骨折发生率的目标。

Fall is an interaction result of internal and external factors of the body in the old people. Fall is happened frequently in senile persons, it＇s an important figure of aging. A low energy injury induced fracture happens will be often belonged to osteoporotic fracture, which is also named as fragile fracture. Occurrence of fragile fracture means the decline of bone structure and exhaustion of bone function. Health condition, accompanied diseases, genetic factors, men- tal and psychological status, behaviors and living environments, gait steady, as well as drugs intake are all the risk factors of fall in aged persons. About 9% of all old people will suffer the fractures after fall. Besides the intervention of external stress force, the bone mineral density and bone quality reduced are also lead to the bone mechanical strength weakness; this is also a key factor of osteoporotic fracture. Some diseases suffered and drugs intake could affect the bone mineral density and bone quality, height of a person, BMI, nutrition situation, gonadal function, VitD insufficienay and prior-fracture history are significant factors for predicting the risks of fragile fractures. A lot of tool for predicting the risks of fall or fragile fracture, FRAX is the most common used method all of the world, which is recommended by WHO as well. Analysis of risk factors will be helpful to identify the individuals who are under the high risk of fall or fragile fracture. The fall and fracture accident of senile people will decline, if the risk factors could be prevent and intervene. It is the most efficient way that has been proved in practice. To improve the analysis system of risk factors individually, monitoring and formulating the intervention process will be effective to reach the target for reducing the falls and fractures in senile persons.