Shiga Toshiki, Tsuji Yoshiro, Fujioka Mikihiro, Kubo Toshikazu
Department of Orthopedic Surgery, Nantan General Hospital, Nantan, Kyoto, Japan.
Geriatr Gerontol Int. 2009 Mar;9(1):69-74. doi: 10.1111/j.1447-0594.2008.00510.x.
The purpose of this study was to investigate risk factors for hip fracture in 169 Japanese elderly women.
Patients were divided into three groups: 53 patients had osteoporosis with hip fractures (FX-G), 59 patients had osteoporosis without hip fractures (NFX-G) and 57 patients had low back pain with neither osteoporosis nor hip fracture (NOP-G). Bone mineral density (BMD) of lumbar spine, bone-specific alkaline phosphatase (BAP) and deoxypyridinoline (DPD) were compared among the three groups.
The mean BMD of FX-G and NFX-G was lower than that of NOP-G, but there was no significant difference between FX-G and NFX-G. Although the mean BAP of FX-G was similar to that of NOP-G, both were lower than NFX-G (P < 0.05). However, the mean DPD of FX-G was higher than the other groups (P < 0.05, vs NFX-G, P < 0.001, vs NOP-G). The percentage of patients who showed BAP levels less than 35 IU/L and DPD levels of 7.5 nmoL/mmol-Cr or more, was highest in FX-G (72.7%). This percentage was lower for NFX-G (30.9%) and NOP-G (16.4%). The odds ratio of hip fracture occurring was 5.77 (95% confidence interval, 2.25-14.66).
Bone turnover consisting of increase in bone resorption and decrease in bone formation apart from BMD of lumbar spine resulted in a higher incidence of hip fracture for Japanese elderly women with osteoporosis.
本研究旨在调查169名日本老年女性髋部骨折的危险因素。
患者分为三组：53例患有骨质疏松症并伴有髋部骨折（骨折组），59例患有骨质疏松症但无髋部骨折（无骨折组），57例有腰痛但既无骨质疏松症也无髋部骨折（无骨质疏松症组）。比较三组患者的腰椎骨密度（BMD）、骨特异性碱性磷酸酶（BAP）和脱氧吡啶啉（DPD）。
骨折组和无骨折组的平均骨密度低于无骨质疏松症组，但骨折组和无骨折组之间无显著差异。虽然骨折组的平均BAP与无骨质疏松症组相似，但两者均低于无骨折组（P<0.05）。然而，骨折组的平均DPD高于其他组（与无骨折组相比P<0.05，与无骨质疏松症组相比P<0.001）。BAP水平低于35 IU/L且DPD水平为7.5 nmoL/mmol-Cr或更高的患者百分比，在骨折组中最高（72.7%）；无骨折组（30.9%）和无骨质疏松症组（16.4%）的这一百分比更低。髋部骨折发生的比值比为5.77（95%置信区间，2.25 - 14.66）。
除腰椎骨密度外，骨吸收增加和骨形成减少所构成的骨转换导致患有骨质疏松症的日本老年女性髋部骨折发生率更高。
