Guilley E, Chevalley T, Herrmann F, Baccino D, Hoffmeyer P, Rapin C-H, Rizzoli R
Centre for Interdisciplinary Gerontology, University of Geneva, Geneva, Switzerland.
Osteoporos Int. 2008 Dec;19(12):1741-7. doi: 10.1007/s00198-008-0610-6. Epub 2008 May 17.
In this prospective 10-year study in elderly aged 60 years and over, there was a 1.3% per year reduction in the standardized incidence of hip fracture in women but not in men. This decrease was mainly due to changes in the standardized incidence of hip fracture in institution-dwelling women.
A decrease in age-adjusted hip fracture incidence has been recently demonstrated in some countries. Since a large proportion of hip fractures occur in nursing homes, we analyzed whether this decreasing trend would be more detectable in institution-dwelling elderly compared with community-dwelling elderly.
All hip fracture patients aged 60 years and over were identified in a well-defined area. Incidence of hip fracture, age- and sex-adjusted to the 2000 Geneva population, was computed in community- and institution-dwelling elderly.
From 1991 to 2000, 1,624 (41%) hip fractures were recorded in institutionalized-dwelling elderly and 2,327 (59%) in community-dwelling elderly. The standardized fracture incidence decreased by 1.3% per year in women (p = 0.039), but remained unchanged in men (+0.5%; p = 0.686). Among institution-dwelling women, hip fracture incidence fell by 1.9% per year (p = 0.044), whereas it remained stable among community-dwelling women (+0.0%, p = 0.978). In men, no significant change in hip fracture incidence occurred among institution- or community-dwelling elderly.
The decrease in the standardized hip fracture incidence in institution-dwelling women is responsible for the reversal in secular trend. Future research should include stratification according to the residential status to better identify the causes responsible for the trend in hip fracture incidence.
在这项针对60岁及以上老年人的前瞻性10年研究中，女性髋部骨折的标准化发病率每年下降1.3%，而男性则没有下降。这种下降主要是由于居住在机构中的女性髋部骨折标准化发病率的变化。
最近在一些国家已证实年龄调整后的髋部骨折发病率有所下降。由于很大一部分髋部骨折发生在养老院，我们分析了与居住在社区的老年人相比，这种下降趋势在居住在机构中的老年人中是否更明显。
在一个明确界定的区域内识别出所有60岁及以上的髋部骨折患者。计算居住在社区和机构中的老年人髋部骨折的发病率，并根据2000年日内瓦人口进行年龄和性别调整。
1991年至2000年期间，居住在机构中的老年人中有1624例（41%）髋部骨折被记录，居住在社区中的老年人中有2327例（59%）。女性的标准化骨折发病率每年下降1.3%（p = 0.039），而男性则保持不变（+0.5%；p = 0.686）。在居住在机构中的女性中，髋部骨折发病率每年下降1.9%（p = 0.044），而在居住在社区中的女性中则保持稳定（+0.0%，p = 0.978）。在男性中，居住在机构或社区中的老年人髋部骨折发病率没有显著变化。
居住在机构中的女性标准化髋部骨折发病率的下降导致了长期趋势的逆转。未来的研究应包括根据居住状况进行分层，以更好地确定导致髋部骨折发病率趋势的原因。
