Kannus Pekka, Uusi-Rasi Kirsti, Palvanen Mika, Parkkari Jari
Accident & Trauma Research Center, UKK Institute for Health Promotion Research, Tampere, Finland.
Ann Med. 2005;37(4):303-10. doi: 10.1080/07853890510007197.
Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long-standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a 'simple' fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high-impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called 'fall-induced high-impact injuries' instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal-trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury-site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone-specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor-assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury-site protection, padded strong-shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.
影响老年人的骨折是一项实实在在的公共卫生负担，因为它们是该人群长期疼痛、功能障碍、残疾和死亡的最重要原因之一。骨强度受损（骨质疏松症）和跌倒，单独或更常见的是两者共同作用，是老年人骨折的两个独立且直接的风险因素，所有其他更间接的风险因素，如衰老、缺乏运动、营养不良、吸烟、饮酒、疾病、药物、功能障碍和残疾，都是通过这两个因素起作用的。在这两个因素中，跌倒而非骨质疏松症，是导致骨折的最强单一风险因素。导致老年人骨折最常见的情况是从站立高度或更低高度的“简单”跌倒。尽管一般来说这种类型的创伤仅为轻度或中度（与例如机动车碰撞相比），但对于特定的受伤部位而言，这些创伤是高冲击力损伤，通常会产生明显超过骨骼断裂强度的力量。因此，影响老年人的骨折应被称为“跌倒所致高冲击力损伤”，而不是常用的、部分具有误导性的骨质疏松性骨折或微小创伤骨折等术语。预防老年人骨折包括预防骨质疏松症和跌倒，以及使用损伤部位保护措施预防骨折。关于骨质疏松症，通过定期运动、钙和维生素D使骨量峰值最大化并预防骨质流失，以及用骨特异性药物治疗已确诊的骨质疏松症，都有坚实的科学依据。在预防跌倒方面，定期进行力量和平衡训练、减少精神药物使用，以及补充维生素D和钙的饮食已被证明是有效的。多方面的风险因素评估和干预措施通过同时影响许多跌倒风险因素，在预防老年人跌倒方面也取得了成功。最后，关于损伤部位保护，其有效性已得到科学验证的带衬垫的强力护髋似乎是预防髋部骨折的一个有前景的选择。
