Empana Jean-Philippe, Dargent-Molina Patricia, Bréart Gérard
Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France.
J Am Geriatr Soc. 2004 May;52(5):685-90. doi: 10.1111/j.1532-5415.2004.52203.x.
To assess whether the occurrence of a hip fracture is associated with an increased risk of mortality even after taking into account age and prefracture health status and whether this increased risk of mortality persists beyond the first 6 months after the fracture.
A prospective study of risk factors for hip fracture.
Five French areas: Amiens, Lyon, Montpellier, Paris, and Toulouse.
The cohort consisted of 7,512 volunteer ambulatory women aged 75 and older who were recruited from voter registration lists. Women who had a history of hip fracture or bilateral hip replacement were excluded.
The baseline examination included a functional and clinical examination and a questionnaire on life style and treatments. Thereafter, women were followed every 4 months for 4 years to record the occurrence of fractures and deaths. A multivariable proportional hazards model was used to determine the association between hip fracture (treated as a time-dependent variable) and mortality, after adjustment for age and baseline health status.
During a mean+/-standard deviation follow-up of 3.9+/-0.9 years, 338 women had a first hip fracture, and their postfracture mortality rate was 112.4 per 1,000 woman-years, compared with 27.3 per 1,000 woman-years for the 6,115 women who did not have any fracture (P<.001). After adjusting for age and baseline health status, women with hip fracture were more than twice as likely to die (95% confidence interval (CI)=1.6-2.8). This increased risk appeared more pronounced in the first 6 months (relative risk (RR)=3.0, 95% CI=1.9-4.7) than after (RR=1.9, 95% CI=1.6-2.2) (P=.09).
In ambulatory elderly women, the occurrence of a hip fracture is associated with an increased risk of death, even after prefracture health status is taken into account. Although the effect of the fracture is stronger in the first 6 months, it persists for several years thereafter, which suggests that prevention of hip fracture and improved care after the fracture may contribute to increase life expectancy in addition to preserving quality of life.
评估即使在考虑年龄和骨折前健康状况之后，髋部骨折的发生是否与死亡风险增加相关，以及这种增加的死亡风险在骨折后的前6个月之后是否仍然存在。
一项关于髋部骨折危险因素的前瞻性研究。
法国五个地区：亚眠、里昂、蒙彼利埃、巴黎和图卢兹。
该队列由7512名年龄在75岁及以上的志愿门诊女性组成，她们是从选民登记名单中招募的。有髋部骨折病史或双侧髋关节置换史的女性被排除在外。
基线检查包括功能和临床检查以及一份关于生活方式和治疗的问卷。此后，对女性进行为期4年、每4个月一次的随访，以记录骨折和死亡的发生情况。在调整年龄和基线健康状况后，使用多变量比例风险模型来确定髋部骨折（视为时间依赖性变量）与死亡率之间的关联。
在平均随访3.9±0.9年期间，338名女性发生了首次髋部骨折，她们骨折后的死亡率为每1000女性年112.4例，而6115名未发生任何骨折的女性的死亡率为每1000女性年27.3例（P<0.001）。在调整年龄和基线健康状况后，髋部骨折女性的死亡可能性是未骨折女性的两倍多（95%置信区间（CI）=1.6-2.8）。这种增加的风险在最初6个月更为明显（相对风险（RR）=3.0，95%CI=1.9-4.7），而在6个月之后则相对较低（RR=1.9，95%CI=1.6-2.2）（P=0.09）。
在门诊老年女性中，即使考虑了骨折前的健康状况，髋部骨折的发生仍与死亡风险增加相关。尽管骨折的影响在最初6个月更强，但此后会持续数年，这表明预防髋部骨折以及骨折后改善护理可能有助于除了保持生活质量之外还能提高预期寿命。
