Melton L J
Section of Clinical Epidemiology, Mayo Clinic, Rochester, MN 55905, USA.
Bone. 1996 Mar;18(3 Suppl):121S-125S. doi: 10.1016/8756-3282(95)00492-0.
Of the fractures linked with osteoporosis, hip fractures are most important in terms of death, functional dependence, and social cost. Reduction of these adverse outcomes depends on preventing hip fractures, which are caused by falling on a biomechanically compromised proximal femur. Skeletal strength depends on the amount of bone and its structural arrangement, whereas the traumatic load on the proximal femur is dictated by the orientation of the fall and other factors. One or several of these underlying mechanisms account for the various risk factors that have been identified for hip fracture, including greater incidence rates among women than men and among white than nonwhite populations. However, the exponentially increasing incidence of hip fractures with age indicates that a complex interplay of factors determines the risk of fracture in each person. The multifactorial nature of the problem suggests that hip fractures will be difficult to prevent even as the fractures and their associated costs continue to rise with the increased number of older people. However, the variability of hip fracture rates within high risk populations in Europe and North America reflects the existence of other powerful risk factors that, if identified, might provide the basis for more effective interventions.
在与骨质疏松症相关的骨折中，就死亡率、功能依赖和社会成本而言，髋部骨折最为重要。减少这些不良后果取决于预防髋部骨折，而髋部骨折是由于跌倒在生物力学上受损的股骨近端所致。骨骼强度取决于骨量及其结构排列，而股骨近端的创伤负荷则由跌倒的方向和其他因素决定。这些潜在机制中的一种或几种导致了已确定的髋部骨折的各种风险因素，包括女性的发病率高于男性，白人的发病率高于非白人人群。然而，髋部骨折的发病率随年龄呈指数增长，这表明多种因素的复杂相互作用决定了每个人的骨折风险。这个问题的多因素性质表明，即使随着老年人数量的增加，骨折及其相关成本持续上升，髋部骨折仍将难以预防。然而，欧洲和北美的高危人群中髋部骨折发生率的差异反映出存在其他强大的风险因素，如果能识别这些因素，可能会为更有效的干预措施提供依据。
