Singh Inderpal, Duric Daniel, Motoc Alfe, Edwards Chris, Anwar Anser
Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Ystrad Mynach, Wales CF82 7EP, UK.
Health Education and Improvement Wales (HEIW), Caerphilly, Wales CF15 7QQ, UK.
Geriatrics (Basel). 2020 Nov 30;5(4):99. doi: 10.3390/geriatrics5040099.
dementia increases the risk of falls by 2-3 times and cognitively impaired patients are three times more likely to have hip fracture following a fall when compared to cognitively intact individuals. However, there is not enough evidence that explores the relationship between dementia and fragility fractures. The aim of this study is to explore the relationships of prevalent fragility fracture in patients with dementia admitted with an acute illness to the hospital. the existing Health Board records were reviewed retrospectively for all patients admitted diagnosed with dementia in the year 2016. All patients were followed up for a maximum of three years. All of the the dementia patients were divided into three groups: group 1-"no fractures"; group 2-"all fractures"; group 3-"fragility fractures". Clinical outcomes were analysed for hospital stay, discharge destination (new care home), post-discharge hip fracture data, and mortality. dementia patients with a prevalent fracture were significantly older, 62% were women. A significantly higher proportion of dementia patients with prevalent fractures were care home residents and taking a significantly higher number of medications. The mean Charlson comorbidity index was similar in patients with or without fracture. Dementia patients with a prevalent fracture required a new care home and this is significantly higher when compared to those with no fracture. Mortality at one year and three year was not statistically different in patients with or without prevalent fractures. A significantly higher number (21.5%) of dementia patients with prevalent fragility fracture sustained a new hip fracture when compared to those with no prevalent osteoporotic fracture (2.9%) over the three years follow up ( < 0.0001). dementia patients with a prevalent fragility fracture is associated with a statistically significant higher risk of a new care home placement following acute hospital admission. This sub-group is also at risk of a new hip fracture in the next three years. Whilst clinical judgement remains crucial in the care of frail older people, it is prudent to consider medical management of osteoporosis in dementia if deemed to be beneficial following the comprehensive geriatric assessment.
痴呆症使跌倒风险增加2至3倍，认知受损患者跌倒后发生髋部骨折的可能性是认知未受损个体的三倍。然而，尚无足够证据探究痴呆症与脆性骨折之间的关系。本研究旨在探讨因急性疾病入院的痴呆症患者中普遍存在的脆性骨折之间的关系。对2016年所有确诊为痴呆症的住院患者的现有健康委员会记录进行了回顾性审查。所有患者最多随访三年。所有痴呆症患者分为三组：第1组——“无骨折”；第2组——“所有骨折”；第3组——“脆性骨折”。对住院时间、出院去向（新的疗养院）、出院后髋部骨折数据和死亡率等临床结果进行了分析。患有普遍性骨折的痴呆症患者年龄显著更大，62%为女性。患有普遍性骨折的痴呆症患者中，居住在疗养院的比例显著更高，服用的药物数量也显著更多。有骨折和无骨折患者的平均查尔森合并症指数相似。患有普遍性骨折的痴呆症患者需要入住新的疗养院，这一比例显著高于无骨折患者。有普遍性骨折和无普遍性骨折患者在1年和3年时的死亡率无统计学差异。在三年随访中，患有普遍性脆性骨折的痴呆症患者发生新的髋部骨折的比例（21.5%）显著高于无普遍性骨质疏松性骨折的患者（2.9%）（<0.0001）。患有普遍性脆性骨折的痴呆症患者在急性入院后入住新疗养院的风险在统计学上显著更高。这一亚组在未来三年内也有发生新的髋部骨折的风险。虽然临床判断在体弱老年人的护理中仍然至关重要，但如果在综合老年评估后认为有益，在痴呆症患者中考虑骨质疏松症的药物治疗是谨慎的做法。
