Ramírez-Martín Raquel, Castell Alcalá María Victoria, Alarcón Teresa, Queipo Rocío, Ríos Germán Peggy Paola, Otero Puime Ángel, González-Montalvo Juan Ignacio
Department of Geriatrics, La Paz University Hospital, Madrid, Spain.
La Paz University Hospital Research Institute, IdiPAZ, Madrid, Spain.
Fam Pract. 2017 Nov 16;34(6):679-684. doi: 10.1093/fampra/cmx059.
Hip fracture (HF) is by far the most common serious fragility fracture. Its care is a major challenge to all healthcare systems.
To determine whether there are characteristics of older people identified via comprehensive geriatric assessment (CGA) that help identify those with an increased risk of HF.
The demographic, functional, cognitive and nutritional data of a cohort of patients admitted for acute HF were compared with those of a population cohort representing community-dwelling older people in the same urban district without HF. Bivariate analysis was performed on the variables in both the complete samples and in a subsample of age and sex paired subjects, followed by logistic regression analysis.
A total of 509 HF patients and 1315 community-dwelling older people were included. The HF patients were older and more frequently women and had more frequent disability and cognitive impairment, lower handgrip strength, lower body mass index (BMI) and a higher frequency of vitamin D deficiency compared with the community controls (P < 0.001). The variables most strongly associated with the presence of HF in the multivariate analysis, aside from age and female sex, were BMI<22 kg/m2 [odds ratio (OR) = 5.11], disability (OR = 4.32), muscle weakness (OR = 3.01), and vitamin D deficiency (OR = 2.13).
There are easily obtained CGA determinants that are strongly associated with fragility HF. The detection of low weight, disability, malnutrition, muscle weakness, and vitamin D deficiency can help identify at-risk older people to implement prevention strategies.
髋部骨折（HF）是目前最常见的严重脆性骨折。其护理对所有医疗保健系统都是一项重大挑战。
确定通过综合老年评估（CGA）识别出的老年人特征是否有助于识别髋部骨折风险增加的人群。
将一组因急性髋部骨折入院患者的人口统计学、功能、认知和营养数据与代表同一市区无髋部骨折的社区居住老年人的人群队列数据进行比较。对完整样本以及年龄和性别配对受试者的子样本中的变量进行双变量分析，随后进行逻辑回归分析。
共纳入509例髋部骨折患者和1315例社区居住老年人。与社区对照组相比，髋部骨折患者年龄更大，女性更常见，残疾和认知障碍更频繁，握力更低，体重指数（BMI）更低，维生素D缺乏频率更高（P<0.001）。在多变量分析中，除年龄和女性性别外，与髋部骨折存在最密切相关的变量是BMI<22kg/m²[比值比（OR）=5.11]、残疾（OR = 4.32）、肌肉无力（OR = 3.01）和维生素D缺乏（OR = 2.13）。
存在与脆性髋部骨折密切相关的易于获得的CGA决定因素。检测低体重、残疾、营养不良、肌肉无力和维生素D缺乏有助于识别高危老年人以实施预防策略。
