School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada.
Roth | McFarlane Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Care London, 268 Grosvenor Street, London, ON, Canada.
Arch Osteoporos. 2018 Mar 20;13(1):32. doi: 10.1007/s11657-018-0445-5.
UNLABELLED: In a prospective cohort of 113 patients followed 4 years after distal radius fracture (DRF), 24% of patients experienced a subsequent fall and 19% experienced a subsequent fracture. People with poor balance, greater fracture-specific pain/disability, low bone density, and prior falls had nearly a three times higher risk of subsequent falls. PURPOSE: To determine the extent to which modifiable risk factors alone or in combination with bone mineral density (BMD) and non-modifiable risk factors predict subsequent falls and osteoporotic (OP) fractures after distal radius fracture (DRF). METHODS: We assessed a cohort of patients (n = 191; mean age = 62 ± 8 years; female = 88%) shortly after DRF (baseline) and again at 4 years to identify subsequent falls or OP fractures. Baseline predictors included age, sex, prior falls, and modifiable risk factors such as balance, muscle strength, physical activity, fear of falling, BMD, fracture-specific pain/disability, and general health status. Univariate, multivariate, and stepwise logistic regression analyses were conducted to compute odds ratio (OR) with 95% CI to determine the extent of association between the risk factors and outcomes. RESULTS: Among the 113 patients, who completed 4-year follow-up, 24% reported ≥ 1 subsequent fall and 19% reported ≥ 1 subsequent fracture. Significant predictors of subsequent falls included poor balance (OR = 3.3), low total hip BMD (OR = 3.3), high patient-rated wrist evaluation (PRWE) score (OR = 3.0), and prior falls (OR = 3.4). When adjusted for BMD, age, and sex; only prior falls (OR = 4.1) remained a significant independent predictor of future falls. None of the modifiable or non-modifiable risk factors were significantly associated with subsequent fractures. CONCLUSION: Prior falls (≥ 2) is an independent predictor of subsequent falls in patients with DRF. In clinical practice, screening of patients for prior falls, balance, fracture-specific pain/disability, and BMD may identify those who might be at risk of subsequent falls after their first DRF.
目的：确定可改变的风险因素单独或与骨密度（BMD）和不可改变的风险因素结合，在多大程度上可以预测桡骨远端骨折（DRF）后再次发生跌倒和骨质疏松性（OP）骨折。 方法：我们在 DRF 后不久（基线）评估了一组患者（n=191；平均年龄=62±8 岁；女性=88%），并在 4 年后再次评估，以确定是否发生了后续跌倒或 OP 骨折。基线预测因素包括年龄、性别、既往跌倒和可改变的风险因素，如平衡、肌肉力量、身体活动、跌倒恐惧、BMD、骨折特异性疼痛/残疾和一般健康状况。进行单变量、多变量和逐步逻辑回归分析，以计算优势比（OR）及其 95%置信区间，以确定风险因素与结果之间的关联程度。 结果：在完成 4 年随访的 113 名患者中，24%报告≥1 次后续跌倒，19%报告≥1 次后续骨折。后续跌倒的显著预测因素包括平衡不佳（OR=3.3）、总髋部 BMD 低（OR=3.3）、患者自评腕部评估（PRWE）评分高（OR=3.0）和既往跌倒（OR=3.4）。在调整 BMD、年龄和性别后，仅既往跌倒（OR=4.1）仍然是未来跌倒的显著独立预测因素。可改变或不可改变的风险因素均与后续骨折无显著相关性。 结论：既往跌倒（≥2 次）是 DRF 患者再次跌倒的独立预测因素。在临床实践中，对患者进行既往跌倒、平衡、骨折特异性疼痛/残疾和 BMD 的筛查可能会识别出那些在首次 DRF 后可能有再次跌倒风险的患者。
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