Barcelos Anabela, Lopes David G, Canhão Helena, da Cunha Branco Jaime, Rodrigues Ana Maria
NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal.
Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal.
Bone Rep. 2021 Oct 27;15:101139. doi: 10.1016/j.bonr.2021.101139. eCollection 2021 Dec.
Multimorbidity is a worldwide health problem, especially in elderly patients who have a higher risk of fragility fracture. Currently, there is insufficient knowledge about the burden of multimorbidity in patients with previous fragility fracture. The aim of this study was to evaluate the association between multimorbidity and previous fragility fracture, and to assess the effect of fragility fracture and/or multimorbidity in the perception of quality-of-life and physical function, in women 50 years of age and older.
Women aged ≥50 years from the EpiReumaPt study (2011-2013), a nationwide population-based study, were evaluated. Self-reported data regarding sociodemographics, health-related quality of life, physical functioning, fragility fracture, and multimorbidity were collected using a semi-structured questionnaire. Multimorbidity was defined as 2 or more chronic non-communicable diseases. Descriptive exploratory analysis of the data was performed using hypothesis testing. Multiple logistic regression modelling was used to assess the association between multimorbidity and fragility fractures, and linear regression was used for the quality-of-life and physical function outcomes.
The estimated prevalence of fragility fracture in women older than 50 years was 17.5%. A higher prevalence of multimorbidity (74.6%) was found in the group of women with previous fragility fracture than in those without previous fragility fracture. Multivariate logistic regression analysis revealed that women with multimorbidity had a higher odds of fragility fracture (adjusted odds ratio, 1.38; 95% confidence interval, 1.12-1.69), compared with women with 1 or no self-reported non-communicable chronic diseases. In women with previous fragility fracture, rheumatic diseases (62.7%) and hypertension (58.6%) were the most frequently self-reported non-communicable chronic diseases. The combination of fragility fracture and multimorbidity was associated with a lower quality of life and higher degree of disability.
Women 50 years and older with multimorbidity had a significantly increased odds of fragility fracture. Fragility fracture combined with multimorbidity was negatively associated with quality of life and positively associated with disability. This study emphasizes the need to redesign health services to care for patients to prevent non-communicable chronic diseases and fragility fracture, particularly in women 50 years and older, in whom these diseases are likely to potentiate the risk of fragility fracture.
多病共存是一个全球性的健康问题，在有更高脆性骨折风险的老年患者中尤为突出。目前，对于既往有脆性骨折的患者中多病共存的负担了解不足。本研究的目的是评估多病共存与既往脆性骨折之间的关联，并评估脆性骨折和/或多病共存对50岁及以上女性生活质量和身体功能认知的影响。
对来自EpiReumaPt研究（2011 - 2013年）的年龄≥50岁的女性进行评估，该研究是一项基于全国人口的研究。使用半结构化问卷收集有关社会人口统计学、健康相关生活质量、身体功能、脆性骨折和多病共存的自我报告数据。多病共存定义为患有两种或更多种慢性非传染性疾病。使用假设检验对数据进行描述性探索性分析。采用多元逻辑回归模型评估多病共存与脆性骨折之间的关联，采用线性回归分析生活质量和身体功能结局。
50岁以上女性脆性骨折的估计患病率为17.5%。既往有脆性骨折的女性组中多病共存的患病率（74.6%）高于无既往脆性骨折的女性组。多变量逻辑回归分析显示，与报告有1种或无自我报告的非传染性慢性病的女性相比，患有多病共存的女性发生脆性骨折的几率更高（调整后的优势比为1.38；95%置信区间为1.12 - 1.69）。在既往有脆性骨折的女性中，风湿性疾病（62.7%）和高血压（58.6%）是最常自我报告的非传染性慢性病。脆性骨折和多病共存的组合与较低的生活质量和较高的残疾程度相关。
50岁及以上患有多病共存的女性发生脆性骨折的几率显著增加。脆性骨折与多病共存相结合与生活质量呈负相关，与残疾呈正相关。本研究强调需要重新设计医疗服务以照顾患者，预防非传染性慢性病和脆性骨折，特别是在50岁及以上的女性中，这些疾病可能会增加脆性骨折的风险。
