Melton L J, Beard C M, Kokmen E, Atkinson E J, O'Fallon W M
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905.
J Am Geriatr Soc. 1994 Jun;42(6):614-9. doi: 10.1111/j.1532-5415.1994.tb06859.x.
To assess the risk of fracture following onset of Alzheimer's disease.
Retrospective (historical) cohort study.
Population-based in Rochester, Minnesota.
All 543 Rochester residents with onset of Alzheimer's disease during the 10-year period, 1975-84, and an equal number of age- and sex-matched controls from the community.
Fractures were assessed through review of each subject's complete (inpatient and outpatient) medical records in the community.
Rochester residents with Alzheimer's disease were no more likely to have a history of fracture prior to onset than were matched controls from the same population. During the year of onset, there was a 2-fold excess of fractures at various sites among those with Alzheimer's disease. The risk ratio for any fracture subsequently was 1.1 (95% CI 0.9, 1.3), and this slight increase was accounted for entirely by a 2.7-fold increase in the risk of hip fracture (95% CI 1.8, 4.2).
Fracture risk was not increased before the onset of Alzheimer's disease, although there was an excess of fractures around the time that Alzheimer's disease came to clinical attention. Fracture risk was not elevated thereafter except for a substantial increase in the risk of hip fracture. This suggests a link with certain falls rather than generalized disuse osteoporosis.
评估阿尔茨海默病发病后骨折的风险。
回顾性（历史性）队列研究。
基于明尼苏达州罗切斯特市的人群研究。
1975年至1984年这10年间发病的所有543名罗切斯特市居民中的阿尔茨海默病患者，以及来自社区的同等数量、年龄和性别匹配的对照者。
通过查阅社区中每位受试者完整的（住院和门诊）医疗记录来评估骨折情况。
与来自同一人群的匹配对照者相比，患有阿尔茨海默病的罗切斯特市居民在发病前有骨折病史的可能性并无差异。在发病当年，阿尔茨海默病患者在各个部位的骨折发生率高出2倍。随后发生任何骨折的风险比为1.1（95%可信区间0.9，1.3），而这种轻微增加完全是由髋部骨折风险增加2.7倍所致（95%可信区间1.8，4.2）。
在阿尔茨海默病发病前骨折风险并未增加，尽管在阿尔茨海默病引起临床关注时周围骨折发生率有所增加。此后，除了髋部骨折风险大幅增加外，骨折风险并未升高。这表明与某些跌倒有关，而非普遍的废用性骨质疏松症。
