Department of Nursing, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
Osteoporos Int. 2011 Aug;22(8):2385-93. doi: 10.1007/s00198-010-1446-4. Epub 2010 Oct 21.
Three modifiable factors of fall direction, poor bone strength, and depression were associated with an increased risk of hip fractures for elderly men and women; fall direction was a much stronger predictor than the other two. When a fall occurs, changing fall direction may be most effective to prevent hip fractures.
A matched case-control study was conducted to identify risk factors for hip fractures in elderly men and women in Taiwan.
Cases were defined as persons who visited the emergency room due to a fall and were diagnosed with a first hip fracture. For each case, a control was matched by gender and time of falling, selected from persons who sought care at the same emergency room due to a fall resulting in injury other than a hip fracture. In total, 85 paired men and 221 paired women were included.
For men, backward, straight-down, and sideways falls were associated with 10.8-, 13.6-, and 15.2-fold increased risks of hip fractures, respectively, compared with forward falls. Poor bone strength and depression were associated with 2.27- and 2.85-fold increased risks of hip fractures, respectively, while dependence in ≥3 activities of daily living was associated with a fivefold lower risk. For women, compared with forward falls, backward, straight-down, and sideways falls were associated with 10.2-, 9.86-, and 12.8-fold increased risks of hip fractures, respectively. Living in a rented house, poor bone strength, depression, and use of antidiabetics were associated with 1.65-, 2.78-, 1.89-, and 1.92-fold increased risks of hip fractures, respectively. Hormone replacement therapy was associated with a fivefold lower risk of hip fractures.
While bone strength and depression can be risk factors for hip fractures in elderly people, the direction of the fall was the strongest predictor. Some risk factors differed between elderly men and women.
本病例对照研究旨在确定台湾地区老年男性和女性髋部骨折的危险因素。
病例组定义为因跌倒而到急诊就诊并被诊断为首次髋部骨折的患者。对于每个病例，按照性别和跌倒时间匹配一名对照组，从因跌倒而导致髋部以外骨折到同一急诊就诊的患者中选择。共纳入 85 对男性和 221 对女性。
对于男性，与前向跌倒相比，后向、直下和侧方跌倒分别与髋部骨折风险增加 10.8 倍、13.6 倍和 15.2 倍相关。骨强度差和抑郁分别与髋部骨折风险增加 2.27 倍和 2.85 倍相关，而≥3 项日常生活活动依赖与风险降低 5 倍相关。对于女性，与前向跌倒相比，后向、直下和侧方跌倒分别与髋部骨折风险增加 10.2 倍、9.86 倍和 12.8 倍相关。居住在出租房、骨强度差、抑郁和使用降糖药分别与髋部骨折风险增加 1.65 倍、2.78 倍、1.89 倍和 1.92 倍相关。激素替代疗法与髋部骨折风险降低 5 倍相关。
虽然骨强度和抑郁可能是老年人群髋部骨折的危险因素，但跌倒的方向是最强的预测因素。一些危险因素在老年男性和女性中存在差异。
