Ruan Wen-Dong, Wang Pei, Ma Xin-Long, Ge Rui-Ping, Zhou Xian-Hu
Department of Orthopedics, General Hospital of Tianjin Medical University, Tianjin 300052, China.
Chin J Traumatol. 2011 Apr 1;14(2):74-8.
To explore the clinical characteristics and risk factors of refracture in patients suffering from osteoporosis-related fractures as well as effective interventions.
From January 2006 to January 2008, both out-patients and in-patients in our hospital who were over 50 years old and suffered from osteoporosis-related fractures were selected for this research. They were divided into fracture group and refracture group. The refracture rate was followed up for 2 years, during which 11 patients developed refracture, thus were included in the refracture group. Therefore, 273 patients, 225 first-fracture cases, aged (67.7+/-8.5) years, and 48 refracture cases, aged (72.7+/-9.5) years, were included in this study. General data including age and sex, fracture types, femoral neck bone mineral density (BMD) T-scores tested by dual-energy X-rays absorptiometry (DEXA), Charlson index, time-frame between two fractures as well as mobility skill assessment were collected and analyzed by single-factor and multivariate statistical methods.
Females accounted for 70.2% of the fracture group and 77.1% of the refracture group. The most common refracture type was vertebral fracture for the first time and femoral neck fracture for the second time during the follow-up. The second fracture happened 3.7 years after the first one on average. The refracture rate was 2.12% within one year, and 4.66% within two years. Risk factors for a second fracture in osteoporotic fracture patients included age (larger than 75 years, HR equal to 1.23, 95%CI 1.18-1.29; larger than 85 years, HR equal to 1.68, 95% CI 1.60-1.76), female sex (HR equal to 1.36, 95%CI 1.32-1.40), prior vertebral fractures (HR equal to 1.62, 95%CI 1.01-2.07), prior hip fractures (HR equal to 1.27, 95%CI 0.89-2.42), BMD T-score less than -3.5 (HR equal to 1.38, 95%CI 1.17-1.72) and weakened motor skills (HR equal to 1.27, 95%CI 1.09-1.40).
The risks of second fracture among patients with initial brittle fracture are substantial. There is adequate time between the first and second fractures for interventions to reduce the risks of refracture, especially for the old women with a vertebral or hip fracture. Medication, motor functional rehabilitation and fall-down prevention training are helpful.
探讨骨质疏松性骨折患者再骨折的临床特征、危险因素及有效干预措施。
选取2006年1月至2008年1月我院50岁以上骨质疏松性骨折门诊及住院患者进行研究。分为骨折组和再骨折组。随访2年再骨折发生率，期间有11例发生再骨折，纳入再骨折组。本研究共纳入273例患者，其中初次骨折225例，年龄（67.7±8.5）岁，再骨折48例，年龄（72.7±9.5）岁。收集年龄、性别、骨折类型、双能X线吸收法（DEXA）检测的股骨颈骨密度（BMD）T值、Charlson指数、两次骨折间隔时间以及活动技能评估等一般资料，采用单因素和多因素统计方法进行分析。
骨折组女性占70.2%，再骨折组女性占77.1%。随访期间最常见的再骨折类型为首次椎体骨折，第二次股骨颈骨折。第二次骨折平均发生在第一次骨折后3.7年。1年内再骨折发生率为2.12%，2年内为4.66%。骨质疏松性骨折患者再次骨折的危险因素包括年龄（大于75岁，HR=1.23，95%CI 1.18-1.29；大于85岁，HR=1.68，95%CI 1.60-1.76）、女性（HR=1.36，95%CI 1.32-1.40）、既往椎体骨折（HR=1.62，95%CI 1.01-2.07）、既往髋部骨折（HR=1.27，95%CI 0.89-2.42）、BMD T值小于-3.5（HR=1.38，95%CI 1.17-1.72）以及运动技能减弱（HR=1.27，95%CI 1.09-1.40）。
初次脆性骨折患者再次骨折风险较高。首次和第二次骨折之间有足够时间进行干预以降低再骨折风险，尤其是对于有椎体或髋部骨折的老年女性。药物治疗、运动功能康复和预防跌倒训练有帮助。
