Porter R W, Miller C G, Grainger D, Palmer S B
Doncaster Royal Infirmary.
BMJ. 1990 Sep 29;301(6753):638-41. doi: 10.1136/bmj.301.6753.638.
To assess the relative importance of osteoporosis of the os calcis, cognisance, and mobility in the risk of subsequent fracture of the hip in elderly women.
Prospective study of elderly women in residential care over two years.
21 Private or 38 local authority residential homes for the elderly and 4 geriatric hospitals in Doncaster and Hull.
1414 Ambulant women aged over 69, in private or local authority residential care or geriatric care. Those who had had bilateral hip surgery were excluded.
Broad band ultrasonic attenuation (BUA) index, Clifton assessment procedures for the elderly test (for cognisance), and mobility on a six point scale, and fracture of the hip in the subsequent two year period.
73 Women fractured their hip during the two years. Their mean age was not significantly different from that of the women who did not have a fracture (85.3 (SD 5.6) v 83.9 (6.3); p = 0.07), but their mean BUA index (40.3 (19.3) v 50.9 (22.2) db/MH2), and score for cognisance (median 19 (interquartile range 10.5-27.0) v 24 (17-30)) were significantly lower (both p less than 0.001). These variables had independent associations with fracture of the hip. Women with fractures had a significantly lower score for the psychomotor component of the cognisance test (4.5 (1-8) v 7 (2-10); p less than 0.0025 and were significantly more mobile (1(1-3) v 3 (1-6); p less than 0.02). Subdividing women according to high, medium, and low scores for BUA index and cognisance testing disclosed a high risk group (118 women) with low BUA index and cognisance score, whose incidence of fracture was 12.8%; in the group at lowest risk (136 women) with high BUA index and cognisance score, the incidence of fracture was only 1.5% (relative risk 8.4 (95% confidence interval -2.0 to 35.5]. Further analysis showed that those most at risk were, additionally, most mobile but that less mobile women with good cognisance had a low incidence of fractures, regardless of the BUA index, (1.2%, high index, v 0.9%, low index).
Elderly women most at risk of sustaining hip fractures were those with low BUA index, low cognisance test score, and high mobility. Improving bone strength and cognisance in elderly women may reduce their incidence of hip fracture.
评估老年女性跟骨骨质疏松、认知能力及活动能力对随后髋部骨折风险的相对重要性。
对接受两年住院护理的老年女性进行前瞻性研究。
唐卡斯特和赫尔的21家私立或38家地方政府养老院以及4家老年医院。
1414名69岁以上、在私立或地方政府养老院或老年护理机构中生活且能走动的女性。排除双侧髋关节手术史者。
宽带超声衰减（BUA）指数、老年人Clifton评估程序测试（用于认知能力）、六点活动能力量表，以及随后两年内的髋部骨折情况。
73名女性在两年内发生髋部骨折。她们的平均年龄与未发生骨折的女性相比无显著差异（85.3（标准差5.6）对83.9（6.3）；p = 0.07），但她们的平均BUA指数（40.3（19.3）对50.9（22.2）db/MH2）及认知能力得分（中位数19（四分位间距10.5 - 27.0）对24（17 - 30））显著更低（均p < 0.001）。这些变量与髋部骨折独立相关。发生骨折的女性在认知能力测试的精神运动部分得分显著更低（4.5（1 - 8）对7（2 - 10）；p < 0.0025），且活动能力显著更强（1（1 - 3）对3（1 - 6）；p < 0.02）。根据BUA指数和认知能力测试的高、中、低得分对女性进行细分，发现一个高风险组（118名女性），其BUA指数和认知能力得分较低，骨折发生率为12.8%；在最低风险组（136名女性），其BUA指数和认知能力得分较高，骨折发生率仅为1.5%（相对风险8.4（95%置信区间 - 2.0至35.5））。进一步分析表明，风险最高的人群也是活动能力最强的，但认知能力良好的活动能力较弱的女性骨折发生率较低，无论BUA指数如何（高指数组为1.2%，低指数组为0.9%）。
发生髋部骨折风险最高的老年女性是那些BUA指数低、认知能力测试得分低且活动能力强的女性。改善老年女性的骨强度和认知能力可能会降低她们髋部骨折的发生率。
