Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA.
Boston University School of Medicine, Boston, MA, USA.
J Bone Miner Metab. 2021 Sep;39(5):893-902. doi: 10.1007/s00774-021-01230-5. Epub 2021 May 15.
Among the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors.
We searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor.
Thirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight < 58 kg (128 lbs) (pooled OR 4.01, 95% CI 1.62-9.90), underweight body mass index (BMI) (< 18.5) (pooled OR 2.83, 95% CI 1.82-4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04-4.97), inactivity (pooled OR 2.14, 95% CI 1.21-3.77), weight loss (pooled OR 1.88, 95% CI 1.32-2.68), consumption of ≥ 27 g (approx. > 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12-2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22-1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI (> 30) (pooled OR 0.58, 95% CI 0.34-0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66-0.80).
Modifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.
在迄今为止探索的各种髋部骨折预测因素中，可改变的风险因素值得特别关注，因为它们为预防措施提供了有希望的目标。本系统评价和荟萃分析旨在评估各种可改变的风险因素。
我们于 2017 年 9 月在四个在线数据库中进行了搜索。我们纳入了报告与脆性髋部骨折相关的可改变生活方式风险因素的研究。使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。纳入标准包括：（1）患有骨质疏松性髋部骨折的成年患者；（2）原始研究；（3）可用英文全文文章；（4）报告可改变的生活方式风险因素。
共有 35 项研究，总计纳入 1508366 例患者，纳入本研究。与髋部骨折风险增加显著相关的可改变风险因素包括：体重<58kg（128 磅）（合并 OR 4.01，95%CI 1.62-9.90）、体重指数（BMI）<18.5（合并 OR 2.83，95%CI 1.82-4.39）、每天饮用≥3 杯咖啡（合并 OR 2.27，95%CI 1.04-4.97）、不活动（合并 OR 2.14，95%CI 1.21-3.77）、体重减轻（合并 OR 1.88，95%CI 1.32-2.68）、每天饮用≥27g（约>2 标准饮料）酒精（合并 OR 1.54，95%CI 1.12-2.13）和当前吸烟（合并 OR 1.50，95%CI 1.22-1.85）。相反，两个因素与髋部骨折风险降低显著相关：肥胖 BMI（>30）（合并 OR 0.58，95%CI 0.34-0.99）和习惯性饮茶（合并 OR 0.72，95%CI 0.66-0.80）。
可改变的因素可以在临床上用于为高危人群提供更有效的生活方式干预。我们发现，低体重和体重不足 BMI 的风险最高，其次是高咖啡摄入量、不活动、体重减轻和高每日饮酒量。
