Division of Orthopedic and Trauma Surgery and Medical Research Center, Department of Surgery, Faculty of Medicine, University of Oulu, Oulu, Finland.
Department of Anatomy and Cell Biology, Faculty of Medicine, University of Oulu, Oulu, Finland.
Arch Orthop Trauma Surg. 2023 May;143(5):2261-2271. doi: 10.1007/s00402-022-04406-4. Epub 2022 Mar 15.
The life-time risk of a second fragile hip fracture is 8.4%, but the risk factors that predispose to a second hip fracture remain unresolved. This study aimed to define risk factors that predisposed patients to a second hip fracture.
For this retrospective study, we retrieved clinical data on 1130 patients with fragile hip fractures (67.2% female, mean age: 79.3 years) that underwent surgery at the Oulu University Hospital in 2013-2016. These data included the fracture risk assessment score (measured with the FRAX tool), the bone-mass T-score, laboratory values, ambulatory capacity, and the time of death.
In this population, 12.4% of patients sustained a second hip fracture. The predisposing factors for a second hip fracture were: female (p = 0.016), a high FRAX score (p = 0.020), and low physical capacity (p < 0.001). The vitamin D level recommended for treating osteoporosis (i.e., vitamin D > 75 nmol/l) was observed in only 24% of patients, and 42% of patients had ionized calcium levels below the reference range. According to the level of the cross-linked carboxy-terminal telopeptide of type I collagen (ICTP), 37% of patients did not have high bone turnover. We found a positive correlation between age and ICTP (p = 0.001). The risk of death was higher after the second hip fracture (p = 0.005), but we found no difference in age between patients with first and second hip fractures (p = 0.11).
After a hip fracture, a second hip fracture is a well-known risk. Nevertheless, we found that only one-third of patients with a second hip fracture had used anti-osteoporosis medication at any time previously. These findings suggested that second hip fractures were most likely to occur in patients with osteopenic T-score values, in women more often than men, and in patients with high FRAX scores and low ambulatory capacity.
第二次髋部脆性骨折的终生风险为 8.4%，但导致第二次髋部骨折的风险因素仍未得到解决。本研究旨在确定导致患者发生第二次髋部骨折的风险因素。
本回顾性研究检索了 2013 年至 2016 年在奥卢大学医院接受手术治疗的 1130 例髋部脆性骨折患者（67.2%为女性，平均年龄：79.3 岁）的临床数据。这些数据包括骨折风险评估评分（采用 FRAX 工具测量）、骨量 T 评分、实验室值、活动能力和死亡时间。
在该人群中，12.4%的患者发生了第二次髋部骨折。导致第二次髋部骨折的易患因素为：女性（p=0.016）、高 FRAX 评分（p=0.020）和低身体活动能力（p<0.001）。仅 24%的患者维生素 D 水平达到治疗骨质疏松症的推荐水平（即维生素 D>75nmol/l），42%的患者离子钙水平低于参考范围。根据 I 型胶原交联羧基末端肽（ICTP）的水平，37%的患者不存在高骨转换。我们发现年龄与 ICTP 呈正相关（p=0.001）。第二次髋部骨折后死亡风险更高（p=0.005），但我们发现第一次和第二次髋部骨折患者的年龄无差异（p=0.11）。
髋部骨折后，再次发生髋部骨折是一个已知的风险。然而，我们发现，只有三分之一的第二次髋部骨折患者在任何时候都使用过抗骨质疏松药物。这些发现表明，第二次髋部骨折最可能发生在 T 评分值为骨质疏松的患者中，女性比男性更常见，而且发生在 FRAX 评分高和活动能力低的患者中。
