Pfister Alfred K, Welch Christine A, Emmett Mary K
From the Department of Medicine, West Virginia School of Medicine, and the Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia.
South Med J. 2014 Mar;107(3):165-72. doi: 10.1097/SMJ.0000000000000072.
To determine in men and women aged 50 years or older the proportion of distal forearm fractures related to high- or low-energy events and subsequent fracturing.
We reviewed records of patients presenting to emergency departments and urgent care facilities with distal forearm fractures occurring during a 7-year entry period and studied for an additional 3.5 years.
High-energy events proportionally were 3.25 times more likely in men, whereas low-energy distal forearm fractures proportionally were 7.98 times more likely in women. Although 25% received bone densitometry evaluations, only 3.59% were performed within the first year after a distal forearm fracture. Osteoporosis and osteopenia did not differ between high- and low-energy distal forearm fractures. In logistic regression, subsequent fractures were associated with prior fracture and age 80 years or older. The occurrence of individuals subsequently fracturing was similar in men and women. Compared with controls, the odds ratio of individuals subsequently fracturing was 1.74 (95% confidence interval 1.32-2.30) in women and 1.9 (95% confidence interval 1.07-3.43) in men. Approximately 60% of total subsequent fractures occurred within 3 years. Osteoporosis was significantly more in patients with distal forearm fractures than controls (P < 0.001), but control patients had significantly more osteopenia (P < 0.001). No differences were noted in therapeutic intervention between those with prior distal forearm fractures and controls.
Regardless of trauma occurrence, both men and women age 50 years and older with recent distal forearm fractures should be evaluated early for treatment by bone densitometry and clinical risk factors because the majority of recurrent fractures occur within 3 years.
确定50岁及以上男性和女性中，与高能量或低能量事件相关的前臂远端骨折比例以及后续骨折情况。
我们回顾了在7年入组期内出现前臂远端骨折并在急诊室和紧急护理机构就诊的患者记录，并进行了另外3.5年的研究。
高能量事件在男性中的比例是女性的3.25倍，而低能量前臂远端骨折在女性中的比例是男性的7.98倍。尽管25%的患者接受了骨密度评估，但只有3.59%是在前臂远端骨折后的第一年内进行的。骨质疏松症和骨质减少在高能量和低能量前臂远端骨折之间没有差异。在逻辑回归分析中，后续骨折与既往骨折及80岁及以上年龄相关。男性和女性后续骨折的发生率相似。与对照组相比，女性后续骨折的比值比为1.74（95%置信区间1.32 - 2.30），男性为1.9（95%置信区间1.07 - 3.43）。约60%的后续骨折发生在3年内。前臂远端骨折患者的骨质疏松症明显多于对照组（P < 0.001），但对照组患者的骨质减少明显更多（P < 0.001）。既往有前臂远端骨折的患者与对照组在治疗干预方面没有差异。
无论是否发生创伤，50岁及以上近期有前臂远端骨折的男性和女性都应尽早通过骨密度测定和临床风险因素进行治疗评估，因为大多数复发性骨折发生在3年内。
