Nevitt M C, Cummings S R
Department of Epidemiology and Biostatistics, University of California, San Francisco 94143-0886.
J Am Geriatr Soc. 1993 Nov;41(11):1226-34. doi: 10.1111/j.1532-5415.1993.tb07307.x.
To determine the causes of hip or wrist fractures.
Case-control analysis nested in a prospective cohort study.
Four clinical centers in Baltimore, Maryland, Minneapolis, Minnesota, Portland, Oregon, and Monessen, Pennsylvania.
Non-black women age 65 and older living in the community.
We measured bone density, arm strength, and anthropometric characteristics at a baseline examination. Those who subsequently suffered hip (n = 130) or wrist (n = 294) fractures as a result of a fall and a consecutive sample of those who fell without a fracture (n = 467) were interviewed about their falls.
In multivariate analyses, those who suffered hip fractures were more likely to have fallen sideways or straight down (odds ratio 3.3; 95% confidence interval 2.0 to 5.6) and to have landed on or near the hip (32.5; 9.9, 107.1) than women who fell without a fracture. Among women who fell on the hip, those with hip fractures were taller (1.5; 1.2, 2.2 per SD increase), less likely to have landed on a hand (0.3; 0.1 to 0.6) or to break the fall by grabbing or hitting an object (0.4; 0.2, 0.9), had weaker triceps (1.7; 1.2, 2.5 per SD decrease), and were more likely to land on a hard surface (2.8; 1.4, 5.5) than those without fractures. Women with wrist fractures were more likely to have fallen backward (2.2; 1.3, 3.8) and to have landed on a hand (20.4; 11.5, 36.0) than those who fell without a fracture. Among women who fell on the hand, those with wrist fractures were taller (1.4; 1.1, 1.8 per SD increase) and less likely to break the fall by grabbing or hitting an object (0.4; 0.2, 0.7). Among women who fell on their hip or hand, the risk of fracturing that site more than doubled for each standard deviation decrease in bone density at the site of fracture.
The nature of the fall determines the type of fracture, while bone density and factors that increase or attenuate the force of impact of the fall determine whether a fracture will occur when a faller lands on a particular bone. These findings have important implications for prevention of fractures in older women.
确定髋部或腕部骨折的病因。
嵌套于前瞻性队列研究中的病例对照分析。
马里兰州巴尔的摩、明尼苏达州明尼阿波利斯、俄勒冈州波特兰和宾夕法尼亚州莫内森的四个临床中心。
居住在社区的65岁及以上非黑人女性。
在基线检查时测量骨密度、手臂力量和人体测量特征。对那些随后因跌倒而发生髋部骨折（n = 130）或腕部骨折（n = 294）的患者以及连续抽取的未发生骨折的跌倒者（n = 467）进行跌倒情况访谈。
在多变量分析中，与未发生骨折的跌倒女性相比，发生髋部骨折的女性更有可能向侧面或直接摔倒（比值比3.3；95%置信区间2.0至5.6），且摔倒时臀部或臀部附近着地的可能性更大（32.5；9.9，107.1）。在臀部着地的女性中，发生髋部骨折的女性更高（每标准差增加1.5；1.2，2.2），手部着地的可能性更小（0.3；0.1至0.6），通过抓住或撞击物体来缓冲跌倒的可能性更小（0.4；0.2，0.9），三头肌力量更弱（每标准差降低1.7；1.2，2.5），且更有可能摔倒在坚硬表面（2.8；1.4，5.5）。与未发生骨折的跌倒女性相比，发生腕部骨折的女性更有可能向后摔倒（2.2；1.3，3.8）且手部着地的可能性更大（20.4；11.5，36.0）。在手部着地的女性中，发生腕部骨折的女性更高（每标准差增加1.4；1.1，1.8），通过抓住或撞击物体来缓冲跌倒的可能性更小（0.4；0.2，0.7）。在臀部或手部着地的女性中，骨折部位的骨密度每降低一个标准差，该部位骨折的风险就会增加一倍以上。
跌倒的性质决定了骨折的类型，而骨密度以及增加或减弱跌倒冲击力的因素决定了跌倒者落在特定骨骼上时是否会发生骨折。这些发现对老年女性骨折的预防具有重要意义。
