老年人的静息-活动模式与跌倒和骨折。
Rest-activity patterns and falls and fractures in older men.
机构信息
Center for Musculoskeletal Health and Department of Internal Medicine, University of California, Davis Medical Center, 4625 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA.
California Pacific Medical Center Research Institute, San Francisco, CA, USA.
出版信息
Osteoporos Int. 2017 Apr;28(4):1313-1322. doi: 10.1007/s00198-016-3874-2. Epub 2016 Dec 24.
UNLABELLED
Dysregulated rest-activity rhythm (RAR) patterns have been associated with several health conditions in older adults. This study showed that later acrophase was associated with a modestly greater risk of falls but not fractures in elderly men. Associations between dysregulated RAR patterns and osteoporosis risk warrant further investigation.
PURPOSE
The purpose of this study was to investigate the relationship between rest-activity rhythm (RAR) patterns and risk of falls/fractures in older men. We hypothesized that dysregulated RAR would be associated with incident falls/fractures.
METHODS
We used wrist-worn actigraphy to measure RAR over 4.8 ± 0.8 24-h periods in men (≥67 years) enrolled in the multicenter Outcomes of Sleep Disorders in Men (MrOS Sleep) Study (n = 3001). Men were contacted every 4 months to report occurrence of falls/fractures. RAR parameters included amplitude (difference between peak and nadir activity in counts/minute), mesor (activity counts/minute), acrophase (time of day of peak activity), and pseudo-F statistic (rhythm robustness) and were evaluated as continuous variables with associations reported per SD increase/decrease in models adjusted for confounders. Logistic regression was used to estimate the likelihood (odds ratio, OR) of recurrent falls in the year after the visit. Proportional hazards models were used to estimate the risk (hazard ratio, HR) of fractures.
RESULTS
One year after the visit, 417 men (14%) had recurrent (≥2) falls. Later acrophase (OR 1.18, 95% CI 1.06-1.32) was associated with a modestly greater likelihood of falls. In 8.6 years (SD 2.6 years) of >97% complete follow-up, 256 men (8.53%) had a major osteoporotic fracture, 85 (2.8%) had a clinical spine fracture, and 110 (3.7%) had a hip fracture. No consistent, significant associations were observed between RAR patterns and fractures.
CONCLUSIONS
Later acrophase was associated with a modestly greater risk of falls; this association did not translate into a higher fracture risk in this cohort of elderly men.
目的
本研究旨在探讨老年人的 rest-activity rhythm（RAR）模式与跌倒/骨折风险之间的关系。我们假设失调的 RAR 与新发跌倒/骨折有关。
方法
我们使用腕戴式活动记录仪在男性（≥67 岁）参加多中心睡眠障碍男性研究（MrOS Sleep 研究）（n=3001）中测量了 4.8±0.8 个 24 小时周期的 RAR。男性每 4 个月报告一次跌倒/骨折的发生情况。RAR 参数包括振幅（每分钟活动的峰值和谷值之间的差异）、中值（每分钟的活动计数）、峰相（活动峰值的时间）和伪-F 统计量（节律稳健性），并作为连续变量进行评估，在调整混杂因素的模型中，每增加/减少一个标准差报告关联。使用逻辑回归来估计随访后一年内再次发生跌倒的可能性（比值比，OR）。使用比例风险模型估计骨折的风险（风险比，HR）。
结果
在随访后的 1 年内，417 名男性（14%）发生了≥2 次跌倒的复发性跌倒。较晚的峰相（OR 1.18，95%CI 1.06-1.32）与跌倒的可能性略有增加相关。在 8.6 年（SD 2.6 年）的 >97%完整随访中，256 名男性（8.53%）发生了主要骨质疏松性骨折，85 名（2.8%）发生了临床脊柱骨折，110 名（3.7%）发生了髋部骨折。在这个老年男性队列中，没有观察到 RAR 模式与骨折之间存在一致、显著的关联。
结论
较晚的峰相与跌倒风险略有增加相关；但这种关联并未转化为该队列中老年人骨折风险的增加。
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