Magaziner J, Wehren L, Hawkes W G, Orwig D, Hebel J R, Fredman L, Stone K, Zimmerman S, Hochberg M C
Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 W. Redwood Street, Suite 200, Baltimore, MD, 21201, USA.
Osteoporos Int. 2006;17(7):971-7. doi: 10.1007/s00198-006-0092-3. Epub 2006 Apr 7.
Hip fracture is a major public health problem, annually affecting over 350,000 persons in the United States and 1.6 million worldwide. Consequences include decreased survival, loss of independence, and increased risk of subsequent fractures. A substantial decline in bone mineral density (BMD) also occurs, yet the magnitude of the decline specifically attributable to hip fracture has not been documented.
To determine the amount of BMD decline attributable to hip fracture, the rate of decline in BMD in a cohort of hip fracture patients was compared with that in a cohort of women of similar age and BMD but without hip fracture. All subjects were community dwelling when enrolled. Hip fracture patients in the Baltimore Hip Studies (BHS) came from two hospitals in Baltimore, Maryland, from 1992 through 1995; comparison subjects came from the Study of Osteoporotic Fracture (SOF) enrolled in four areas of the United States during the same period. Eighty-four white, female hip fracture patients 65 years and older from the BHS were compared with 168 SOF participants matched on age, race, and BMD at baseline. BMD of the femoral neck and total hip was measured by dual-energy x-ray absorptiometry.
Hip fracture patients had a greater decline in BMD during the 12-month postfracture follow-up than that expected on the basis of the nonfracture cohort: 4.9% vs. 0.4% at the femoral neck and 3.5% vs. 0.7% for the total hip. The decline in BMD in hip fracture patients was 11.8 times the amount expected at the femoral neck (matched on age and baseline BMD and adjusted for between-cohort differences in smoking prevalence) and 4.9 times that expected for the total hip at the end of 1 year after the hip fracture.
In this sample of older women, bone loss over the year following hip fracture far exceeded that expected and is an important clinical management concern.
髋部骨折是一个重大的公共卫生问题，在美国每年影响超过35万人，在全球范围内影响160万人。其后果包括生存率下降、失去独立生活能力以及后续骨折风险增加。骨矿物质密度（BMD）也会大幅下降，但具体因髋部骨折导致的下降幅度尚无记录。
为确定髋部骨折导致的BMD下降量，将一组髋部骨折患者的BMD下降率与一组年龄和BMD相似但无髋部骨折的女性队列的下降率进行比较。所有受试者在入组时均居住在社区。巴尔的摩髋部研究（BHS）中的髋部骨折患者来自马里兰州巴尔的摩的两家医院，时间为1992年至1995年；对照受试者来自同期在美国四个地区开展的骨质疏松性骨折研究（SOF）。将BHS中84名65岁及以上的白人女性髋部骨折患者与168名在年龄、种族和基线BMD方面匹配的SOF参与者进行比较。通过双能X线吸收法测量股骨颈和全髋的BMD。
髋部骨折患者在骨折后12个月的随访期间BMD下降幅度大于非骨折队列预期：股骨颈处为4.9% 对0.4%，全髋为3.5% 对0.7%。髋部骨折患者的BMD下降幅度是股骨颈预期下降量的11.8倍（在年龄和基线BMD匹配并针对队列间吸烟患病率差异进行调整后），是髋部骨折后1年末全髋预期下降量的4.9倍。
在这个老年女性样本中，髋部骨折后一年内的骨质流失远远超过预期，是临床管理中的一个重要问题。
