Bernstein David N, Davis Jacob T, Fairbanks Carson, McWilliam-Ross Kindra, Ring David, Sanchez Hugo B
Research performed at the University of Rochester School of Medicine & Dentistry, Rochester, NY, USA; University of Texas Health Science Center, Fort Worth, TX, USA; Texas Health Resources Harris Methodist Hospital, Forth Worth, TX, USA; and Dell Medical School, The University of Texas, Austin, TX, USA.
University of Rochester School of Medicine & Dentistry, Rochester, USA.
Arch Bone Jt Surg. 2018 Nov;6(6):517-522.
A better understanding of how bone mineral density and vitamin D levels are associated with femoral neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years, is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years, is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score?
In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for a hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture type using patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptive statistics, bivariate analyses and multivariable regression were performed.
Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochanteric femur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D level and either fracture type. There was no association between vitamin D level and bone mineral density.
Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochanteric region than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes the importance of bone mineral density screening to assist with intertrochanteric hip fracture prevention.
III.
更好地理解骨矿物质密度和维生素D水平与股骨颈及转子间髋部骨折的关联，可能有助于为医疗服务提供者提供信息。我们提出以下问题：1）在年龄≥55岁的患者中，考虑其他因素后，股骨颈骨折患者与转子间区域骨折患者的足跟定量超声（QUS）t值是否存在差异？2）在年龄≥55岁的患者中，考虑其他因素后，股骨颈骨折患者与转子间区域骨折患者的维生素D水平是否存在差异？3）维生素D水平与QUS t值之间是否存在关联？
在这项回顾性队列研究中，通过2010年12月至2013年9月期间用于髋部骨折固定的CPT编码识别出1030例患者。纳入年龄≥55岁、因从站立高度跌倒后接受髋部骨折手术治疗的患者。三名骨科医生根据患者的X光片对骨折类型进行分类。入院时测定QUS t值和维生素D水平。进行描述性统计、双变量分析和多变量回归分析。
考虑潜在混杂因素后，QUS t值较低的患者发生转子间股骨骨折的可能性高于股骨颈骨折。在双变量分析中，维生素D水平与任何一种骨折类型均无关联。维生素D水平与骨矿物质密度之间也无关联。
髋部骨折的骨密度较低的患者，转子间区域骨折的可能性高于股骨颈骨折，但维生素D水平与之无关。认识到这种关联强调了骨矿物质密度筛查对预防转子间髋部骨折的重要性。
III级。
