Browner W S, Pressman A R, Nevitt M C, Cummings S R
Department of Epidemiology and Biostatistics, University of California-San Francisco, USA.
Arch Intern Med. 1996 Jul 22;156(14):1521-5.
Most investigators have hypothesized that the increase in mortality following osteoporotic fractures reflects poor underlying health status in addition to the acute effects of the fracture.
We observed 9704 ambulatory women aged 65 years or older enrolled in the Study of Osteoporotic Fractures. We obtained reports of fractures and deaths every 4 months and reviewed death certificates and hospital discharge summaries. Multivariable proportional hazards models were used to determine the association between fractures and age-adjusted mortality.
During a mean follow-up of 5.9 years, 1737 women had nonspine fractures, with a postfracture mortality rate of 3 per 100 woman-years, compared with 1.8 per 100 woman-years in those who did not have fractures (P < .001). After adjusting for other factors associated with mortality, women (n = 361) with fractures of the hip or pelvis had a 2.4-fold (95% confidence interval, 1.7-3.3) increase in mortality. However, only 9 (14%) of the 64 deaths that occurred after hip or pelvic fractures were caused or hastened by the fracture. By contrast, 11 (17%) of these deaths seemed to have been a result of chronic conditions that has contributed to the hip or pelvic fracture, and 44 (69%) of the deaths were not clearly related to the fracture.
Mortality is increased following several types of fractures in older women. Most of the increase following hip and pelvic fractures is due to underlying conditions and probably would not be affected by reductions in the incidence of these fractures.
大多数研究者推测，骨质疏松性骨折后死亡率的增加除了反映骨折的急性影响外，还反映了潜在的健康状况不佳。
我们观察了9704名65岁及以上参加骨质疏松性骨折研究的门诊女性。我们每4个月获取一次骨折和死亡报告，并审查死亡证明和医院出院小结。使用多变量比例风险模型来确定骨折与年龄调整后死亡率之间的关联。
在平均5.9年的随访期间，1737名女性发生了非脊柱骨折，骨折后死亡率为每100女性年3例，而未发生骨折的女性为每100女性年1.8例（P <.001）。在调整了与死亡率相关的其他因素后，髋部或骨盆骨折的女性（n = 361）死亡率增加了2.4倍（95%置信区间，1.7 - 3.3）。然而，髋部或骨盆骨折后发生的64例死亡中，只有9例（14%）是由骨折导致或加速的。相比之下，这些死亡中有11例（17%）似乎是导致髋部或骨盆骨折的慢性疾病的结果，44例（69%）死亡与骨折没有明显关系。
老年女性发生几种类型的骨折后死亡率会增加。髋部和骨盆骨折后死亡率增加的大部分原因是潜在疾病，可能不会因这些骨折发病率的降低而受到影响。
