Dukas Laurent, Schacht Erich, Stähelin Hannes B
Geriatric University Clinic, Kantonsspital, Basel, Switzerland.
Osteoporos Int. 2005 Dec;16(12):1683-90. doi: 10.1007/s00198-005-1903-7. Epub 2005 Jun 3.
Recently, a low creatinine clearance (CrCl) of < 65 ml/min was described as a new significant and independent risk factor for the number of fallers and falls in a community-dwelling elderly population. In this study we investigated if a low creatinine clearance of < 65 ml/min is also a risk factor for falls and fractures in elderly men and women treated for osteoporosis. In a cross-sectional study with the help of questionnaires we assessed the prevalence of having experienced falls within the last 12 months according to renal function in 5,313 German men and women receiving treatment for osteoporosis. The CrCl was calculated using the established Cockcroft-Gault formula. The prevalence of falls and fractures was assessed in multivariate-controlled logistic regression models according to a CrCl cut off of 65 ml/min. The P-values were two-sided. In this study of elderly men and women treated for osteoporosis (n=5,313), 60.9% (n=3,238) had a CrCl of < 65 ml/min, which was associated in multivariate controlled analyses, compared to a CrCl of > or = 65 ml/min (n=2,075), with a significant increased risk of experiencing falls (1,775/3,238 vs. 773/2,075, OR 1.69, 95% CI 1.50-1.91, P<0.0001) and an increased risk for multiple falls (37.1 vs. 22.6%, OR 1.63, 95% CI 1.42-1.87, P<0.0001). Furthermore, compared to a creatinine clearance of > or = 65 ml/min, a creatinine clearance of < 65 ml/min was also associated with a significant increased multivariate controlled risk for hip fractures (OR 1.57, 95%CI 1.18-2.09, P=0.002), for radial fractures (OR 1.79, 95%CI 1.39-2.31, P=<0.0001), for total vertebral fractures (OR 1.31, 95%CI 1.19-1.55, P=0.003) and for fall-associated vertebral fractures (OR 1.24, 95% CI 1.03-1.54, P=0.031). Similar to community-dwelling elderly, in elderly men and women treated for osteoporosis a CrCl of less than 65 ml/min is a significant and independent risk factor for falls. Furthermore, we could show for the first time that a low creatinine clearance in elderly men and women treated for osteoporosis is also associated with a significantly increased risk of vertebral, hip and radial fractures.
最近，肌酐清除率（CrCl）<65 ml/分钟被描述为社区居住老年人群中跌倒者数量和跌倒次数的一个新的重要独立危险因素。在本研究中，我们调查了CrCl<65 ml/分钟是否也是接受骨质疏松症治疗的老年男性和女性跌倒及骨折的危险因素。在一项横断面研究中，我们借助问卷评估了5313名接受骨质疏松症治疗的德国男性和女性在过去12个月内根据肾功能经历跌倒的患病率。CrCl使用既定的Cockcroft-Gault公式计算。根据CrCl临界值65 ml/分钟，在多变量控制的逻辑回归模型中评估跌倒和骨折的患病率。P值为双侧。在这项对接受骨质疏松症治疗的老年男性和女性（n = 5313）的研究中，60.9%（n = 3238）的CrCl<65 ml/分钟，与CrCl≥65 ml/分钟（n = 2075）相比，在多变量控制分析中，经历跌倒的风险显著增加（1775/3238 vs. 773/2075，OR 1.69，95%CI 1.50 - 1.91，P<0.0001）以及多次跌倒的风险增加（37.1%对22.6%，OR 1.63，95%CI 1.42 - 1.87，P<0.0001）。此外，与肌酐清除率≥65 ml/分钟相比，肌酐清除率<65 ml/分钟还与髋部骨折（OR 1.57，95%CI 1.18 - 2.09，P = 0.002）、桡骨骨折（OR 1.79，95%CI 1.39 - 2.31，P<0.0001）、椎体骨折总数（OR 1.31，95%CI 1.19 - 1.55，P = 0.003）以及跌倒相关椎体骨折（OR 1.24，95%CI 1.03 - 1.54，P = 0.031）的多变量控制风险显著增加相关。与社区居住老年人相似，在接受骨质疏松症治疗的老年男性和女性中，CrCl<65 ml/分钟是跌倒的一个重要独立危险因素。此外，我们首次表明，接受骨质疏松症治疗的老年男性和女性肌酐清除率低还与椎体、髋部和桡骨骨折风险显著增加相关。
