Dargent-Molina P, Favier F, Grandjean H, Baudoin C, Schott A M, Hausherr E, Meunier P J, Bréart G
INSERM, Unité 149, Villejuif, France.
Lancet. 1996 Jul 20;348(9021):145-9. doi: 10.1016/s0140-6736(96)01440-7.
Most hip fractures result from falls. However, the role of fall-related factors has seldom been examined. Comparison of the predictive value of these factors with that of bone mineral density (BMD) has important implications for the prevention of hip fractures.
We assessed femoral-neck BMD by dual-photon X-ray absorptiometry and potential fall-related risk factors, which included self-reported physical capacity, neuromuscular function, mobility, visual function, and use of medication in 7575 women, aged 75 years or older, with no history of hip fracture recruited at five centres in France. We followed up these women every 4 months to record incident hip fractures. During an average of 1.9 years of follow-up 154 women suffered a first hip fracture.
In age-adjusted multivariate analyses, we found four independent fall-related predictors of hip fracture: slower gait speed (relative risk = 1 . 4 for 1 SD decrease [95% Cl 1.1-1.6)]; difficulty in doing a tandem (heel-to-toe) walk (1.2 for 1 point on the difficulty score [1.0-1.5]); reduced visual acuity (2.0 for acuity < or = 2/10 [1.1-3.7]); and small calf circumference (1.5 [1.0-2.2]). After adjustment for femoral-neck BMD, neuromuscular impairment--gait speed, tandem walk--and poor vision remained significantly associated with an increased risk of subsequent hip fracture. With high risk defined as the top quartile of risk, the rate of hip fracture among women classified as high risk based on both a high fall-risk status and low BMD was 29 per 1000 women-years, compared with 11 per 1000 for women classified as high risk by either a high fall-risk status or low BMD; for women classified as low risk based on both criteria the rate was five per 1000.
We conclude that neuromuscular and visual impairments, as well as femoral-neck BMD, are significant and independent predictors of the risk of hip fracture in elderly mobile women, and that their combined assessment improves the prediction of hip fractures.
大多数髋部骨折由跌倒所致。然而，与跌倒相关因素的作用很少被研究。比较这些因素与骨密度（BMD）的预测价值对于预防髋部骨折具有重要意义。
我们通过双能X线吸收法评估了7575名年龄在75岁及以上、无髋部骨折病史的法国五个中心招募的女性的股骨颈骨密度以及潜在的与跌倒相关的危险因素，这些因素包括自我报告的身体能力、神经肌肉功能、活动能力、视觉功能和药物使用情况。我们每4个月对这些女性进行随访以记录新发髋部骨折情况。在平均1.9年的随访期间，154名女性发生了首次髋部骨折。
在年龄调整的多变量分析中，我们发现了四个与跌倒相关的髋部骨折独立预测因素：步态速度较慢（标准差降低1时相对风险 = 1.4 [95%可信区间1.1 - 1.6]）；进行足跟对足尖行走困难（困难评分每增加1分相对风险为1.2 [1.0 - 1.5]）；视力下降（视力≤2/10时相对风险为2.0 [1.1 - 3.7]）；以及小腿周径较小（相对风险为1.5 [1.0 - 2.2]）。在调整股骨颈骨密度后，神经肌肉功能损害（步态速度、足跟对足尖行走）和视力差仍与随后髋部骨折风险增加显著相关。将高风险定义为风险最高的四分位数，基于高跌倒风险状态和低骨密度被分类为高风险的女性中髋部骨折发生率为每1000女性年29例，相比之下，仅基于高跌倒风险状态或低骨密度被分类为高风险的女性中该发生率为每1000女性年11例；基于两项标准被分类为低风险的女性中该发生率为每1000女性年5例。
我们得出结论，神经肌肉和视觉功能损害以及股骨颈骨密度是老年可活动女性髋部骨折风险的重要且独立的预测因素，并且对它们进行综合评估可改善对髋部骨折的预测。
