Vega E M, Mautalen C A, Carrilero P, Wittich A, Otaño Sahores A, Silberman F S
Sección Osteopatías Médicas, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Medicina (B Aires). 1996;56(4):353-62.
During one year (6/93-5/94) we performed a prospective study in patients with hip fracture, treated at the Hospital de Clínicas. A total of 102 women 52 to 94 years of age (Mean +/- 1SD: 79.5 +/- 9.1 years) and 17 men 61 to 98 years of age (79.7 +/- 9.9 years) who had sustained a hip fracture due to mild or moderate trauma were included. The ratio women: men was 6:1. We also studied 55 age-matched control women without diseases that could affect the skeleton or previous hip fracture (77.1 +/- 5.8 years of age). We did not study a control group in men. Women with hip fractures had lower weight (p < 0.01), lower age of onset of the menopause (p < 0.01) and a tendency to have with a greater frequency a mother with hip fracture (p < 0.08) compared with age-matched controls. When vertebral fractures were excluded, 44% of the hip fracture women had sustained previous skeletal fractures, while only 16% of the age-matched controls had suffered previous skeletal fractures (p < 0.001) (Table 2). The most frequent previous skeletal fractures were wrist and humerus. Forty eight percent of hip fracture women had had at least one vertebral fracture. About 17% of the hip fractured men had sustained previous skeletal fractures, while 5/12 men had suffered at least one vertebral fracture. Hip fractured women and men sustained greater history of diseases which provoke postural instability (Table 3). Biochemical determinations showed significantly diminished levels of serum albumin (p < 0.001) and calcium (p < 0.01), and increased serum PTH (p < 0.05) compared to age-matched controls (Table 4). Bone mineral density (determined by dual energy X-ray absorptiometry) was significantly diminished over proximal femur, total skeleton, legs and pelvis (p < 0.001), head and spine (p < 0.05) (Table 5). Body composition measurements showed that hip fracture women had a significantly lower lean mass compared with controls (p < 0.05). Fat mass also was lower in fracture patients compared with controls, but the difference was not statistically significant (Table 5). We conclude that hip fracture in our population is related to several previous factors: earlier onset of menopause, lower nutrition and body weight, previous diseases that increase the likelihood of falling, increased levels of PTH and reduced bone mass. Prevention of hip fractures should take into account all these factors, specially those that could be modified.
在一年期间（1993年6月至1994年5月），我们在临床医院对髋部骨折患者进行了一项前瞻性研究。纳入了102名年龄在52至94岁（平均±1标准差：79.5±9.1岁）的女性和17名年龄在61至98岁（79.7±9.9岁）的男性，他们因轻度或中度创伤而发生髋部骨折。女性与男性的比例为6:1。我们还研究了55名年龄匹配的无可能影响骨骼或既往髋部骨折疾病的对照女性（年龄77.1±5.8岁）。我们未对男性设立对照组。与年龄匹配的对照组相比，髋部骨折女性体重较低（p<0.01），绝经起始年龄较低（p<0.01），且母亲发生髋部骨折的频率有更高的趋势（p<0.08）。排除椎体骨折后，44%的髋部骨折女性既往有过骨骼骨折，而年龄匹配的对照组中只有16%曾有过骨骼骨折（p<0.001）（表2）。既往最常见的骨骼骨折部位是腕部和肱骨。48%的髋部骨折女性至少有过一次椎体骨折。约17%的髋部骨折男性既往有过骨骼骨折，而12名男性中有5名至少有过一次椎体骨折。髋部骨折的女性和男性有更多引发姿势不稳的疾病史（表3）。生化测定显示，与年龄匹配的对照组相比，血清白蛋白（p<0.001）和钙（p<0.01）水平显著降低，血清甲状旁腺激素（PTH）水平升高（p<0.05）（表4）。骨密度（通过双能X线吸收法测定）在股骨近端、全身骨骼、腿部和骨盆（p<0.001）、头部和脊柱（p<0.05）显著降低（表5）。身体成分测量显示，髋部骨折女性的瘦体重与对照组相比显著较低（p<0.05）。骨折患者的脂肪量也低于对照组，但差异无统计学意义（表5）。我们得出结论，我们研究人群中的髋部骨折与多个既往因素有关：绝经起始较早、营养和体重较低、既往有增加跌倒可能性的疾病、PTH水平升高以及骨量减少。髋部骨折的预防应考虑所有这些因素，特别是那些可以改变的因素。
