Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany.
Int Orthop. 2012 Dec;36(12):2581-7. doi: 10.1007/s00264-012-1708-1. Epub 2012 Nov 9.
The purpose of this study was to investigate specific risk factors, common fracture locations and possible sex-specific differences in elderly patients with stress fractures.
This analysis enrolled 105 patients (83 women, 22 men) with stress fractures. For the analysis of possible risk factors related to increasing age, data from 82 patients (67 women, 15 men) aged 40 years and older (mean age of 57.4 ± 11.0 years) were compared with that from a younger control group [23 patients (16 women, seven men), mean age 28.4 ± 6.7 years]. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry bone densitometry (DXA) and blood samples were taken.
A total of 211 stress fractures were found. Of these, 177 were found in the study group, of which 90.4 % were located in the lower limb. Lumbar and femoral BMD was significantly lower in elderly patients; however, the BMD of most patients was within the osteopenic or normal range. Within the study group, a total of 83.8 % had a vitamin D insufficiency (<30 μg/l); 75.5 % were not engaged in regular physical activity more than once a week. Overweight patients within the study group had significantly more stress fractures compared to normal weight patients (2.6 ± 1.7 vs. 1.9 ± 1.1, p<0.05).
A similar contribution of risk factors has been found for stress fractures in elderly patients and younger controls of the general population. Stress fracture incidence seems to be rather multifactorial and not based on osteoporotic changes alone. A balanced calcium and vitamin D metabolism seems to be of paramount importance for stress fracture prevention in elderly patients.
本研究旨在探讨老年应力性骨折患者的特定危险因素、常见骨折部位和可能的性别差异。
本分析纳入了 105 例（83 名女性，22 名男性）应力性骨折患者。为了分析与年龄增长相关的可能危险因素，我们比较了 82 例（67 名女性，15 名男性）40 岁及以上（平均年龄 57.4±11.0 岁）患者的数据与年轻对照组[23 例（16 名女性，7 名男性），平均年龄 28.4±6.7 岁]。采用双能 X 线吸收法（DXA）测定骨密度（BMD），采集血样。
共发现 211 例应力性骨折。其中 177 例发生在研究组，90.4%位于下肢。老年患者腰椎和股骨 BMD 明显较低；然而，大多数患者的 BMD 处于骨质疏松或正常范围内。在研究组中，总共有 83.8%的患者维生素 D 不足（<30μg/l）；75.5%的患者每周没有进行超过一次的规律体育锻炼。与正常体重患者相比，研究组超重患者的应力性骨折明显更多（2.6±1.7 比 1.9±1.1，p<0.05）。
在老年患者和一般人群的年轻对照组中，应力性骨折的危险因素具有相似的作用。应力性骨折的发生率似乎是多因素的，不仅仅是基于骨质疏松性改变。平衡钙和维生素 D 代谢对于预防老年患者的应力性骨折至关重要。
