骨质疏松骨折后再骨折的临床风险因素  

Analysis on the risk factors of second fracture in fracture related to osteoporosis

作　　者：阮文东[1] 王沛[1] 雪原[1] 马信龙[2] 周先虎[1] 

机构地区：[1]天津医科大学总医院骨科,天津300052 [2]天津医院骨科

出　　处：《中华骨科杂志》2011年第7期789-793,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨骨质疏松患者初次骨折后发生再骨折的风险及其临床特点。方法收集2006年1月至2008年1月门诊及住院的年龄50岁以上、临床可确诊的骨质疏松骨折患者273例，根据是否有骨质疏松骨折病史分为再骨折组48例和骨折组225例。分析患者一般资料、骨折类型、股骨颈DXA骨密度测定T值、Charlson合并症指数、骨折时间等临床特征，并行运动协调技能评价。结果骨折组年龄（67．7±8．5）岁，再骨折组（72．7±9．5）岁；再骨折组女性占77．1％，高于骨折组女性构成比70．2％；再骨折类型以椎体骨折后再次发生股骨颈骨折最多见，其次为股骨颈骨折后再次发生股骨颈骨折。再骨折发生的风险因素包括高龄（〉75岁，HR=I．23；〉85岁，曰R=1．68）、女性（HR=1．36）、曾发生椎体骨折（HR=1．62）、曾发生髋部骨折（HR=1．27），骨密度-T值〈-3．5（HR=1．38）及运动协调技能减退（HR=1．27）。再骨折平均发生于初次骨折后（3．7±2．5）年。骨折组随访2年内再骨折发生率4。9％（11／225）。结论有初次骨质疏松骨折病史的患者发生再骨折的风险仍然很明显，两次骨折之间有足够的间隔采取措施降低再骨折的风险。特别是对发生椎体、髋部骨折的老年女性应进行干预，进行运动协调技能的康复训练和防跌倒练习。Objective To explore the clinical characteristics and risk factors of re-fracture in patients suffering from osteoporosis-related fractures as well as effective interventions. Methods From January 2006 to January 2008, a total of 273 patients with osteoporosis-related fracture were entered in the study, including out-patients and in-patients who were over 50 years old. The patients were divided into fracture group （n=225） and re-fracture group （n=48）. The re-fracture rate was followed up for 2 years, during which 11 patients developed re-fracture. General data including age and sex, fracture types, femoral neck bone mineral density （BMD） T-scores tested by dual-energy X-rays absorptiometry （DEXA）, Charlson index, time- interval between two fractures as well as mobility skill assessment were collected and analyzed. Results The average age at the first fracture was 67.7±8.5 years vs. 72.7±9.5 years for the re-fracture cases. Female accounted for 70.2% of the fracture group and 77.1% of the re-fracture group. The most common re-fracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the followup. Risk factors for a second fracture in osteoporotic fractures patients include age （〉75 years, HR=l.23; 〉85 years, HR=l.68）, female sex （HR=l.36）, prior vertebral fractures （HR=l.62）, prior hip fractures （HR=l.27）, BMD T-score〈-3.5 （HR=l.38） and weakened motor skills （HR=1.27）. The refracture rate in osteoporosis-related fractures was 4.9% followed up for 2 years. The second fracture happened 3.7 years after the first one on average. Conclusion The risks of second fracture among patients with initial brittle fracture are substantial. Mobility skill assessment is an important risk factor for osteoporosis fractures recurrence. There is adequate time between fracture and re-fracture for effective interventions to prevent or reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication,

关 键 词：骨质疏松 骨折 危险性评估 

分 类 号：R687.3[医药卫生—骨科学]