Wihlborg A, Englund M, Åkesson K, Gerdhem P
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Department of Orthopedics, K54, Karolinska University Hospital, Huddinge, SE-141 86, Stockholm, Sweden,
Osteoporos Int. 2015 Aug;26(8):2101-9. doi: 10.1007/s00198-015-3106-1. Epub 2015 Apr 2.
In a large cohort of elderly women followed for 10 years, we found that balance, gait speed, and self-reported history of fall independently predicted fracture. These clinical risk factors are easily evaluated and therefore advantageous in a clinical setting. They would improve fracture risk assessment and thereby also fracture prevention.
The aim of this study was to identify additional risk factors for osteoporosis-related fracture by investigating the fracture predictive ability of physical performance tests and self-reported history of falls.
In the population-based Osteoporosis Prospective Risk Assessment study (OPRA), 1044 women were recruited at the age of 75 and followed for 10 years. At inclusion, knee extension force, standing balance, gait speed, and bone mineral density (BMD) were examined. Falls the year before investigation was assessed by questionnaire. Cox proportional hazards regression analysis was used to determine fracture hazard ratios (HR) with BMD, history of fracture, BMI, smoking habits, bisphosphonate, vitamin D, glucocorticoid, and alcohol use as covariates. Continuous variables were standardized and HR shown for each standard deviation change.
Of all women, 427 (41%) sustained at least one fracture during the 10-year follow-up. Failing the balance test had an HR of 1.98 (1.18-3.32) for hip fracture. Each standard deviation decrease in gait speed was associated with an HR of 1.37 (1.14-1.64) for hip fracture. Previous fall had an HR of 1.30 (1.03-1.65) for any fracture; 1.39 (1.08-1.79) for any osteoporosis-related fracture; and 1.60 (1.03-2.48) for distal forearm fracture. Knee extension force did not show fracture predictability.
The balance test, gait speed test, and self-reported history of fall all hold independent fracture predictability. Consideration of these clinical risk factors for fracture would improve the fracture risk assessment and subsequently also fracture prevention.
在一个对老年女性进行了10年随访的大型队列研究中，我们发现平衡能力、步速以及自我报告的跌倒史可独立预测骨折。这些临床风险因素易于评估，因此在临床环境中具有优势。它们将改善骨折风险评估，从而也有助于骨折预防。
本研究的目的是通过调查身体性能测试和自我报告的跌倒史的骨折预测能力，来确定骨质疏松症相关骨折的其他风险因素。
在基于人群的骨质疏松症前瞻性风险评估研究（OPRA）中，招募了1044名75岁女性并随访10年。纳入研究时，检查了膝关节伸展力、站立平衡、步速和骨密度（BMD）。通过问卷调查评估调查前一年的跌倒情况。采用Cox比例风险回归分析，以骨密度、骨折史、体重指数、吸烟习惯、双膦酸盐、维生素D、糖皮质激素和饮酒情况作为协变量，确定骨折风险比（HR）。对连续变量进行标准化处理，并显示每标准差变化的HR。
在所有女性中，427名（41%）在10年随访期间至少发生了一次骨折。平衡测试未通过者发生髋部骨折的HR为1.98（1.18 - 3.32）。步速每降低一个标准差，髋部骨折的HR为1.37（1.14 - 1.64）。既往跌倒者发生任何骨折的HR为1.30（1.03 - 1.65）；发生任何骨质疏松症相关骨折的HR为1.39（1.08 - 1.79）；发生桡骨远端骨折的HR为1.60（1.03 - 2.48）。膝关节伸展力未显示出骨折预测性。
平衡测试、步速测试和自我报告的跌倒史均具有独立的骨折预测性。考虑这些骨折的临床风险因素将改善骨折风险评估，进而也有助于骨折预防。
