Department of Geriatrics, Beijing Jishuitan Hospital, 100035, Beijing, China.
Department of Orthopaedic and Traumatology, Beijing Jishuitan Hospital, 100035, Beijing, China.
BMC Musculoskelet Disord. 2022 Oct 28;23(1):941. doi: 10.1186/s12891-022-05880-y.
The mortality rate after hip fracture is high. However, the 1-year mortality rate after femoral intertrochanteric fracture and femoral neck fracture differs (Gibson-Smith D, Klop C, Elders PJ, Welsing PM, van Schoor N, Leufkens HG, et al., Osteoporos Int 25:2555-2563, 2014), although both are types of hip fracture. A previous real-world single-center prospective cohort study showed that older age and high Charlson comorbidity index score were risk factors for femoral intertrochanteric fracture. Additionally, therapy with zoledronic acid 5 mg (Aclasta) was a protective factor (Li XP, Zhang P, Zhu SW, Yang MH, Wu XB, Jiang XY, J Orthop Surg Res. 16:727, 2021). We wished to determine the risk factors for all-cause mortality in femoral neck fracture patients.
To identify the risk factors for postoperative all-cause mortality in aged patients with femoral neck fracture.
We enrolled 307 aged patients with femoral neck fracture; 38 were lost to follow-up after 2-3 years. The patients' general characteristics, bone mineral density, and anti-osteoporosis treatment after operation were recorded as potential risk factors. Kaplan-Meier curves and multivariate Cox proportional hazards models were constructed to analyze the influence of each factor on all-cause mortality.
This was a real-world single-center prospective cohort study showing that (1) most of the patients who died were male, older (mean age of the patients who died: 84.8 years vs. 77.9 years for survivors), and had more comorbidities compared with surviving patients. Previous fracture history, body mass index, femoral neck T score, hemoglobin and 25-hydroxy vitamin D levels did not differ significantly between patients who died vs. survived. (2) Differing from patients with intertrochanteric fractures, older patients with femoral neck fracture experienced no reduction in all-cause mortality with treatment with zoledronic acid.
In Chinese patients with femoral neck fracture, physicians should pay careful attention to male patients, older patients, and those with high numbers of comorbidities.
髋部骨折的死亡率较高。然而，股骨转子间骨折和股骨颈骨折的 1 年死亡率不同（Gibson-Smith D、Klop C、Elders PJ、Welsing PM、van Schoor N、Leufkens HG 等人，Osteoporos Int 25:2555-2563, 2014），尽管两者都是髋部骨折。先前的真实世界单中心前瞻性队列研究表明，年龄较大和较高的 Charlson 合并症指数评分是股骨转子间骨折的危险因素。此外，唑来膦酸 5mg（Aclasta）治疗是一个保护因素（Li XP、Zhang P、Zhu SW、Yang MH、Wu XB、Jiang XY、J Orthop Surg Res. 16:727, 2021）。我们希望确定股骨颈骨折患者全因死亡率的危险因素。
确定股骨颈骨折老年患者术后全因死亡率的危险因素。
我们纳入了 307 例股骨颈骨折老年患者；38 例患者在 2-3 年后失访。记录了患者的一般特征、骨密度和术后抗骨质疏松治疗作为潜在的危险因素。绘制 Kaplan-Meier 曲线和多变量 Cox 比例风险模型，分析各因素对全因死亡率的影响。
这是一项真实世界的单中心前瞻性队列研究，结果显示：（1）大多数死亡患者为男性，年龄较大（死亡患者的平均年龄：84.8 岁，幸存者为 77.9 岁），合并症多于幸存者。既往骨折史、体重指数、股骨颈 T 评分、血红蛋白和 25-羟维生素 D 水平在死亡患者与存活患者之间无显著差异。（2）与转子间骨折患者不同，股骨颈骨折老年患者使用唑来膦酸治疗并未降低全因死亡率。
在中国股骨颈骨折患者中，医生应密切关注男性患者、老年患者和合并症较多的患者。
