老年人群骨质疏松性骨折与跌倒风险的相关性

Association between osteoporotic fracture and fall risk in elderly population

目的 探讨老年人群骨质疏松性骨折与跌倒风险的相关性。方法 对2013年9月至2015年6月在南京鼓楼医院骨质疏松门诊初诊的1 579例50~91岁患者的临床资料进行回顾性分析。收集患者年龄、身高、体质量、慢性病史、手术外伤史、用药史、骨质疏松性骨折史、跌倒风险指数及腰椎（L1-4）和髋部（全髋、股骨颈）骨密度值。排除具有影响骨代谢及平衡能力的相关疾病及用药史的患者,对入组者采用Spearman检验,分析跌倒风险指数与年龄、性别、体质量指数及骨质疏松性骨折之间的相关性,并进行回归分析,得出回归系数及标准化回归系数。结果 年龄、体质量指数、骨质疏松性骨折及腰椎骨密度与跌倒风险指数显著相关（r值依次为0.255、0.108、0.110、0.095,P=0.000）,性别与跌倒风险相关性较弱（r=0.067,P〈0.05）,髋部骨密度与跌倒风险指数未见相关性。线性回归分析显示,各因素与跌倒风险指数相关程度大小依次为年龄、腰椎（L1-4）骨密度、体质量指数、性别及骨质疏松性骨折,标准化回归系数分别为0.225、0.128、0.095、0.094和0.088。将骨质疏松性骨折分类后,对特定骨折与跌倒风险指数相关性进行分析,得出髋部、椎体、多发性骨折与跌倒风险指数显著相关（r值分别为0.093、0.083、0.099,P〈0.01）。分别对其进行回归分析,得出标准化回归系数分别为0.079、0.070、0.077。结论 增龄、高体质量指数、男性与较高的跌倒风险显著相关。髋部、椎体及多发性骨折与较高的跌倒风险显著相关,较高跌倒风险是骨质疏松性骨折的独立风险因素。

Objective To assess the association between the osteoporotic fracture and fall risk in the elderly population. Methods The Clinical data of 1 579 patients aged 50 to 91 years were retrospectively analyzed. Age, height, weight, history of chronic diseases, surgery and trauma, drug use, osteoporotic fracture, fall index （FI）, bone mineral density （BMD） at lumbar spine （ L1_4 ） and proximal hip （ total hip, femoral neck） were collected. After the exclusion of patients with a history of disease and drug use affecting bone metabolism and balance ability, spearman test was used to analyze the correlation between F1 and age, gender, body mass index （BMI） , BMD and osteoporotic fracture. Results Age, BMI, osteoporotic fracture and BMD （ L1-4 ） were significantly correlated with FI （ r values were0.255, 0.108, 0.110, 0.095, P=0.001）, and gender was weakly correlated with FI （r =0.067, P〈 0.05 ） , while hip BMD and FI had no correlation. Linear regression analysis showed that the correlation degree of each factor on FI were age, BMD （ E1-4 ） , BMI, gender and osteoporotie fracture, and the standardized regression coefficients were 0. 225, 0. 128, 0. 095, 0. 094 and 0. 088 respectively. After classification of the osteoporotic fracture, the correlation of the specific osteoporotic fracture and FI were analyzed. The hip, vertebral body and multiple fractures were significantly correlated with FI, and the r values were 0. 093, 0. 083, 0. 099 respectively （P 〈0.01 ）. Further regression analysis show that the standardized regression coefficients were 0. 079, 0. 070, 0. 077. Conclusion The increased age, higher BMI and male were significantly associated with fall risk. There were a significant correlations between the hip, vertebral and multiple fractures and the fall risk, and the fall risk was an independent risk factor for osteoporotic fractures.