Weidauer Lee, Binkley Teresa, Beare Tianna, Minett Maggie, McCormack Lacey, Wey Andrew, Specker Bonny
EA Martin Program in Human Nutrition, South Dakota State University, SWC Box 506, Brookings, SD, 57007, USA,
Clin Orthop Relat Res. 2015 Aug;473(8):2514-20. doi: 10.1007/s11999-015-4248-3.
Falls and fractures are a major public health concern with an economic impact of more than USD 19 billion per year. Extensive research into the risk of falls and fractures in elderly populations has been performed; however, little is known about fall or fracture risk in younger populations. Additionally, sex- and population-specific (rural versus nonrural) fall and fracture risk may be important in identifying groups most at risk in an effort to develop preventive measures.
QUESTIONS/PURPOSES: The purpose of this study was to determine whether sex and population (rural versus nonrural) differences exist in fall and fracture rates.
Data from 1256 (538 men) participants of the South Dakota Rural Bone Health Study, a population-based cohort study, including those living a rural lifestyle (n=349 non-Hutterites and 572 Hutterites) and a nonrural lifestyle (n=335), were used to address our a priori hypotheses. Health histories, physical activity recall, anthropometric measurements, and dual-energy xray absorptiometry measurements of body composition were obtained longitudinally from participants every 18 months for 7.5 years. Falls and fractures were self-reported and fractures were confirmed through medical record review. Incidence rates were calculated as the number of falls or fractures per 1000 person-years and generalized estimating equations determined the association of sex and population group with fall and fractures rates while accounting for the repeated longitudinal measurements on the same person. All models adjusted for age group, percent time in moderate and vigorous physical activity, lean and fat mass, grip strength, and previous diagnosis of osteoarthritis.
Males aged 39 years and younger had a 135% greater fall risk than females in the same age category (p=0.03), but there was no differences between males and females 40 years of age or older (p=0.26; age-by-sex interaction, p=0.05). No sex differences were observed for fracture risk. After controlling for covariates, rural and nonrural individuals fell at higher rates than Hutterites (84% and 50%, respectively, p<0.001). Additionally, rural individuals fractured at a 72% greater rate than Hutterites after controlling for covariates (p=0.03).
Sex differences in fall risk among younger individuals along with population differences in fall and fracture rates suggest that sex and lifestyle factors may have an impact on fall and fracture risk. Future studies focusing on sex- and population-specific risk factors are necessary to develop prevention strategies tailored to specific populations.
Level III, prospective study.
跌倒和骨折是一个重大的公共卫生问题，每年造成的经济影响超过190亿美元。针对老年人群跌倒和骨折风险已经开展了广泛研究；然而，对于年轻人群的跌倒或骨折风险却知之甚少。此外，性别和人群特异性（农村与非农村）的跌倒和骨折风险对于识别高危人群以制定预防措施可能很重要。
问题/目的：本研究的目的是确定跌倒和骨折发生率在性别和人群（农村与非农村）方面是否存在差异。
南达科他州农村骨骼健康研究是一项基于人群的队列研究，共有1256名参与者（538名男性），包括过着农村生活方式的人群（349名非哈特派和572名哈特派）以及非农村生活方式的人群（335名），利用这些数据来验证我们的先验假设。在7.5年的时间里，每18个月对参与者进行一次纵向健康史、体力活动回忆、人体测量以及双能X线吸收法测量身体成分。跌倒和骨折情况通过自我报告获得，骨折情况通过病历审查予以确认。发病率计算为每1000人年的跌倒或骨折次数，广义估计方程确定性别和人群组与跌倒和骨折发生率之间的关联，同时考虑到对同一人的重复纵向测量。所有模型均对年龄组、中度和剧烈体力活动时间百分比、瘦体重和脂肪量、握力以及既往骨关节炎诊断进行了校正。
39岁及以下男性的跌倒风险比同年龄段女性高135%（p=0.03），但40岁及以上男性和女性之间无差异（p=0.26；年龄与性别的交互作用，p=0.05）。未观察到骨折风险的性别差异。在控制协变量后，农村和非农村个体的跌倒发生率高于哈特派（分别为84%和50%，p<0.001）。此外，在控制协变量后，农村个体的骨折发生率比哈特派高72%（p=0.03）。
年轻个体中跌倒风险的性别差异以及跌倒和骨折发生率的人群差异表明，性别和生活方式因素可能对跌倒和骨折风险有影响。未来有必要开展针对性别和人群特异性风险因素的研究，以制定针对特定人群的预防策略。
III级，前瞻性研究。
