体力活动与广东省老年人髋骨骨折关系的病例对照研究

Association of physical activity with risk of hip fractures in elderly in Guangdong: case-control study

目的探讨体力活动与老年人髋骨骨折的关系。方法采用1：1配对病例对照研究，于2008年1月至2013年7月通过面对面访问，对广东省4家医院55—80岁老年人骨质疏松性髋骨骨折新发病例及性别、年龄（±3岁）配对的对照人群进行问卷调查，调查一般情况、近2年日常活动、健康相关行为和骨折家族史等。采用单、多因素条件logistic回归分析体力活动和髋骨骨折的关系，多因素分析校正了年龄、BMI、教育程度、父母骨折史、吸烟饮酒史、服用钙和复合维生素和绝经年限（女性）。结果病例组和对照组共726对，其中男性177对，女性549对。对照组和病例组年龄分别为（70．9±6．9）和（71．0±7．0）岁（P〉0．05）；病例组近2年日均体力活动总能耗和体育锻炼能耗（分别39．5和0．91MET×h／d），分别低于对照组的（53．4和1．60MET×h／d），差异有统计学意义（均P〈0．01）。多因素分析显示，日均体力活动总能耗及体育锻炼能耗最高组人群与最低组相比，患骨折风险较低（OR分别为0．38和0．47），参加体育锻炼者患骨折的风险较不参加者低（OR=0．53）。分层分析显示，高体力活动仅在女性中表现为保护作用，其中日均体力活动总能耗及体育锻炼能耗最高组与最低组相比，患骨折风险较低（OR分别为0．40和0．47），参加体育锻炼者患骨折的风险较不参加者低（OR=0．51）。结论体力活动总量越高和体育锻炼越多，广州市中老年女性髋骨骨折的风险越低。

Objective To assess the association of physical activity with the risk of hip fractures. Methods A 1： 1 matched case-control study was conducted. Cases of incident hip fractures from four hos- pitals and controls matched by age （ 3 years） and sex from hospitals or communities were enrolled between January 2008 and July 2013 in Guangdong Province. Study participants were face-to-face interviewed for general demography, daily activities in recent two years, health related behaviors, and parental history of fractures. Univariate and multivariate conditional logistic regressions were used to test the association be- tween physical activity and risks of hip fracture. Age, BMI, education levels, parental history of fractures, smoking and alcohol drinking, vitamins and calcium supplements, and years since menopause （women） were adjusted for multivariate model. Results There were 726 pairs of cases and controls （ 177 pairs of males and 549 pairs of females）. Ages of cases and controls were （71.0 ± 7. 0） and （70. 9±6. 9） years, respectively （P 〉 0.05 ）. Energy consumption in total physical activity and exercise in recent two years of cases （39. 5 and 0. 91 MET x h/d） were lower than those of controls （53.4 and 1.60 MET × h/d）, P 〈 0. 01 for all. Multivariate analyses showed the risks of hip fractures were lower in the highest energy con- sumption group for total energy consumption of daily average physical activity （OR = 0. 38 ） and energy con-sumption of exercise （ OR = 0. 47 ）, compared with the lowest group ; the risk of fracture in group taking part in physical exercise was lower than that in group without physical exercise （ OR = 0. 53）. Stratified an- alyses revealed that high physical activity showed a protective effect only for women; the risks of hip frac- tures were lower in the highest energy consumption group for total energy consumption of daily average phys- ical activity （ OR = 0.40） and energy consumption of exercise （ OR = 0. 47 ） compared with the lowest group ; the group who participated regular physical exercise had a lower risk of hip fractures than those who did not （ OR = 0. 51 ）. Conclusion Greater levels of total physical activity and exercise were associated with lower risk of hip fractures in the elderly females in Guangdong Province.