上海社区老年人椎体骨折的患病率与危险因素分析

Investigation the prevalence and risk factors of vertebral fracture in community-dwelling elderly in Shanghai

目的研究上海社区老年人椎体骨折的患病率和危险因素。 方法在上海市城镇和郊区5家社区卫生服务中心按照年龄构成比进行分层抽样，纳入65岁以上老年人2 929名，对所有老年人进行胸腰椎X线侧位摄片和问卷调查，采用Genant半定量方法诊断椎体骨折及严重程度，计算椎体骨折患病率，采用logistic回归分析椎体骨折的危险因素。 结果（1）上海社区老人椎体骨折患病率为14.4%，80岁以上年龄组为20.1%，显著高于其他年龄段组（P〈0.05），女性椎体骨折的患病率显著高于男性（18.5%对12.4%，P〈0.05）。（2）椎体骨折最常见好发部位是T12和L1，1度骨折人数比例最高，女性2度与3度骨折总比例明显高于男性，差异有统计学意义（30.6%对17.0%, P〈0.05）。（3）年龄和性别对椎体骨折患病率的影响存在交互作用，男性与女性的椎体骨折风险都随年龄上升，但女性的上升幅度更大（P〈0.001）。（4）Logistic回归显示：女性性别、年龄、父母髋部骨折史、既往骨折史、饮酒是上海社区老年人椎体骨折的危险因素，吸烟、糖皮质激素长期应用和继发性骨质疏松相关疾病与社区老年人椎体骨折无显著相关性。 结论女性的椎体骨折患病率和严重程度都高于男性，年龄对女性椎体骨折的影响大于男性，女性性别、年龄、父母髋部骨折史、既往骨折史、饮酒是上海老年人椎体骨折的危险因素。

ObjectiveTo investigate the prevalence and risk factors of vertebral fractures in the elderlys in Shanghai community. MethodsStratified sampling was performed according to the age distribution of the population in 3 urban and 2 suburban communities in Shanghai, and a total of 2 929 old people aged over 65 years were enrolled. The thoracic and lumbar radiographs and questionnaires were obtained in all the participants. The diagnosis of vertebral fractures were evaluated using Genant′s semi-quantitative method, and the prevalence of vertebral fracture was calculated. Logistic regression was used to analyze the risk factors of vertebral fracture. Results（1） The prevalence of vertebral fractures in community-dwelling elderly was 14.4% totally, and 20.1% in individuals above 80 years old, which was significantly higher than the others （P〈0.05）. The prevalence of vertebral fractures in females was significantly higher than that in males （18.5% vs 12.4%, P〈0.05）. （2） The most common vertebral fracture sites were T12 and L1. Grade 1 vertebral fracture was most common in our cohort. The proportions of grade 2 and grade 3 were significant higher in females than that in males （30.6% vs 17.0%, P〈0.05）. （3） Gender and sex had an interaction effect on the prevalence of vertebral fractures. Prevalence of vertebral fractures increased steadily with age in both genders, although the gradient was steeper for women （P〈0.001）. （4） Logistic regression analysis showed that： female, age, parental hip fracture history, previous fracture history, and alcohol consumption were risk factors of vertebral fractures in community elderly. Smoking, long-term use of glucocorticoid, various diseases associated with secondary osteoporosis had no significant correlation with vertebral fracture. ConclusionThe vertebral fractures were more common and serious in women than in men in community elderly. Age was significantly correlated with the presence of vertebral fracture in women than that in men. Female, age, parental hip fracture history, previous fracture history, and alcohol consumption were risk factors of vertebral fractures in community elderlys.