San Diego State University/University of California, San Diego | Joint Doctoral Program in Public Health (Epidemiology), San Diego, CA, USA.
Department of Family Medicine and Public Health, University of California, San Diego, CA, USA.
Osteoporos Int. 2018 Jan;29(1):163-169. doi: 10.1007/s00198-017-4253-3. Epub 2017 Oct 10.
Hyperkyphosis commonly affects older persons and is associated with morbidity and mortality. Many have hypothesized that hyperkyphosis increases fall risk. Within this prospective study of older adults, kyphosis was significantly associated with incident falls over 1 year. Measures of hyperkyphosis could enhance falls risk assessments during primary care office visits.
To determine the association between four measures of kyphosis and incident and injurious falls in older persons.
Community-dwelling adults aged 65 and older (n = 72) residing in southern California were invited to participate in a prospective cohort study. Participants had kyphosis assessed four ways. Two standing measures included a flexicurve ruler placed against the back to derive a kyphotic index and the Debrunner kyphometer, a protractor used to measure the kyphotic angle in degrees. Two lying measures included the blocks method (number of 1.7 cm blocks needed to achieve a neutral head position while lying supine) and traditional Cobb angle calculation derived from DXA based lateral vertebral assessment. Baseline demographic, clinical, and other health information (including a timed up and go (TUG) test) were assessed at a clinic visit. Participants were followed monthly through email or postcard for 1 year, with falls outcomes confirmed through telephone interview.
Mean age was 77.8 (± 7.1) among the 52 women and 20 men. Over 12 months, 64% of participants experienced at least one incident fall and 35% experienced an injurious fall. Each standard deviation increase in kyphosis resulted in more than doubling the adjusted odds of an incident fall, even after adjusting for TUG. Odds of injurious falls were less consistent across measures; after adjusting for TUG, only the blocks method was associated with injurious falls.
Each kyphosis measure was independently associated with incident falls. Findings were inconsistent for injurious falls; the blocks measure suggested the strongest association. If these findings are replicated, the blocks measure could be incorporated into office visits as a quick and efficient tool to identify patients at increased fall risk.
脊柱后凸症常见于老年人，与发病率和死亡率相关。许多人假设脊柱后凸症会增加跌倒风险。在这项针对老年人的前瞻性研究中，脊柱后凸症与 1 年内的跌倒事件显著相关。脊柱后凸症的测量方法可以增强在初级保健就诊期间进行跌倒风险评估的能力。
确定 4 种脊柱后凸症测量方法与老年人跌倒事件和伤害性跌倒的相关性。
邀请居住在加利福尼亚州南部的 65 岁及以上的社区居住成年人参加前瞻性队列研究。参与者接受了 4 种方法的脊柱后凸症评估。两种站立测量方法包括将 Flexicurve 标尺放在背部以获得后凸指数和 Debrunner 后凸计，这是一种用于测量后凸角度的量角器，以度数表示。两种卧位测量方法包括使用方块法（仰卧位时需要多少个 1.7cm 的方块才能达到中立头部位置）和基于 DXA 对侧位椎体评估的传统 Cobb 角计算。在诊所就诊时评估基线人口统计学、临床和其他健康信息（包括计时起立行走测试（TUG））。参与者通过电子邮件或明信片每月随访 1 年，通过电话访谈确认跌倒结果。
52 名女性和 20 名男性的平均年龄为 77.8（±7.1）岁。在 12 个月期间，64%的参与者至少经历了一次跌倒事件，35%经历了伤害性跌倒。后凸症的标准差每增加一个单位，调整后的跌倒事件发生几率就会增加一倍以上，即使在调整了 TUG 后也是如此。各测量方法与伤害性跌倒的相关性不一致；在调整了 TUG 后，只有方块法与伤害性跌倒相关。
每种脊柱后凸症测量方法都与跌倒事件独立相关。伤害性跌倒的结果不一致；方块法的相关性最强。如果这些发现得到证实，方块法可以作为一种快速有效的工具纳入就诊中，以识别跌倒风险增加的患者。
