INSERM UMR 1033, University of Lyon, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon, Place d'Arsonval, France.
Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth WA 6027, Australia.
J Bone Miner Res. 2024 Apr 19;39(3):252-259. doi: 10.1093/jbmr/zjae014.
Studies on muscle strength and physical function after fracture are focused on short follow-ups and adjacent anatomical region. We compared loss of muscle strength and physical function in men after fracture with normal ageing-related decline. In 823 men aged 60-87, measurements of grip strength and clinical tests (chair stands, balance) were performed every 4 years for 12 years. In 155 men with incident fracture, we compared the status after vs. before the fracture. In men without fracture (controls), we compared the status on the first follow-up (4 years) vs. baseline. In men with fracture, grip strength decreased more than in the controls (41%, 0.28SD, P < .01). Men with fracture had higher risk of incident deterioration on the five chair-stand test vs. the controls (OR = 2.45, P < .001). They had higher risk of incident inability to stand for 10s with closed eyes vs. the controls (OR = 4.80, P < .01). They also had higher risk of deterioration on the tandem walk than the controls: forwards (OR = 2.04, P < .01), backwards (OR = 2.25, P < .005). The rapid physical decline was not limited to the region of the fracture site. In men who had incident non-upper limb fractures, grip strength decreased more (32%, P < .05) vs. the controls. In men who had incident non-lower limb fractures, the risk of decline in the tests of the lower limbs was higher vs. controls (chair stands, OR = 2.73, P < .001). The risk of decline was higher in men with clinical fractures which occurred >1 year before the next visit vs. controls (tandem walk forwards, OR = 2.98, P < .005). Overall, in older men, fractures were associated with greater loss of muscle strength and physical function vs. normal ageing. This accelerated decline was also found in the anatomical regions remote from the fracture site. Thus, programs to decrease or reverse the post-fracture decline could have beneficial effects on subsequent fracture risk.
关于骨折后肌肉力量和身体功能的研究主要集中在短期随访和相邻解剖区域。我们比较了男性骨折后肌肉力量和身体功能的丧失与正常衰老相关的下降。在 823 名 60-87 岁的男性中，每 4 年进行一次握力和临床测试（坐站、平衡）测量，共进行了 12 年。在 155 名发生骨折的男性中，我们比较了骨折前后的状态。在没有骨折的男性（对照组）中，我们比较了第一次随访（4 年）与基线的状态。与对照组相比，骨折男性的握力下降更多（41%，0.28SD，P<.01）。与对照组相比，骨折男性发生 5 次坐站测试新的恶化的风险更高（OR=2.45，P<.001）。他们发生闭眼 10 秒无法站立的风险也高于对照组（OR=4.80，P<.01）。与对照组相比，他们在同步走测试中恶化的风险更高：向前（OR=2.04，P<.01），向后（OR=2.25，P<.005）。快速的身体衰退并不仅限于骨折部位区域。在发生非上肢骨折的男性中，握力下降更多（32%，P<.05），与对照组相比。在发生非下肢骨折的男性中，下肢测试下降的风险高于对照组（坐站，OR=2.73，P<.001）。与对照组相比，在下一次就诊前 1 年以上发生临床骨折的男性，其下降的风险更高（向前同步走，OR=2.98，P<.005）。总体而言，在老年男性中，骨折与肌肉力量和身体功能的更大丧失相关，与正常衰老相比。这种加速衰退也发生在骨折部位以外的解剖区域。因此，减少或逆转骨折后下降的方案可能对随后的骨折风险产生有益影响。
