Schwartz A V, Kelsey J L, Sidney S, Grisso J A
Division of Epidemiology, Stanford University School of Medicine, California.
Osteoporos Int. 1998;8(3):240-6. doi: 10.1007/s001980050060.
The steep rise in hip fracture incidence rates with age is not fully explained by an increase in the frequency of falls or by reduction in bone mineral density, suggesting that circumstances of falls may also affect the risk of hip fracture. Previous studies conducted mainly among women have identified the importance of the orientation of a fall in the etiology of hip fracture. In this case-control study among men of 45 years and older, we evaluated how the circumstances of falls affect the risk of hip fracture. We compared 214 cases with hip fracture due to a fall with 86 controls who had fallen within the past year but did not sustain a hip fracture. As expected, in multivariable age-adjusted analyses men who reported hitting the hip/thigh in a fall had a markedly elevated risk of hip fracture (OR = 97.8; 95% CI = 31.7-302). Hitting the knee in a fall was associated with reduced risk (OR = 0.24; 95% CI = 0.09-0.67). Other factors that were associated with reduced risk of hip fracture among men who fell were more hours of physical activity in the past year (OR = 0.84; 95% CI = 0.73-0.97, for each additional 4 h per week), a greater body mass index (OR = 0.60; 95% CI = 0.40-0.90, for each additional 4 kg/m2), and a history of a fracture when age 45 years or older (OR = 0.26; 95% CI = 0.10-0.69). Reported lower limb dysfunction was associated with increased risk of hip fracture (OR = 6.41; 95% CI = 2.09-19.6) among fallers. The increased risk associated with hitting the hip/thigh in a fall and the reduced risk associated with high body mass index suggest that preventive efforts for older men at high risk might include protective hip pads to reduce the force on the hip in a fall. Exercise and strength training programs may also reduce the risk of hip fracture among men who fall.
髋部骨折发病率随年龄急剧上升，这不能完全用跌倒频率增加或骨矿物质密度降低来解释，这表明跌倒情况也可能影响髋部骨折风险。之前主要在女性中进行的研究已确定跌倒方向在髋部骨折病因学中的重要性。在这项针对45岁及以上男性的病例对照研究中，我们评估了跌倒情况如何影响髋部骨折风险。我们将214例因跌倒导致髋部骨折的病例与86例在过去一年中跌倒但未发生髋部骨折的对照进行了比较。正如预期的那样，在多变量年龄调整分析中，报告在跌倒时撞到髋部/大腿的男性发生髋部骨折的风险显著升高（比值比=97.8；95%置信区间=31.7-302）。跌倒时撞到膝盖与风险降低相关（比值比=0.24；95%置信区间=0.09-0.67）。在跌倒男性中，与髋部骨折风险降低相关的其他因素包括过去一年中更多的体育活动时间（每周每增加4小时，比值比=0.84；95%置信区间=0.73-0.97）、更高的体重指数（每增加4kg/m²，比值比=0.60；95%置信区间=0.40-0.90）以及45岁及以上时的骨折史（比值比=0.26；95%置信区间=0.10-0.69）。报告有下肢功能障碍与跌倒者髋部骨折风险增加相关（比值比=6.41；95%置信区间=2.09-19.6）。跌倒时撞到髋部/大腿相关的风险增加以及高体重指数相关的风险降低表明，针对高危老年男性的预防措施可能包括使用保护性髋垫以减少跌倒时髋部所受的力量。运动和力量训练项目也可能降低跌倒男性的髋部骨折风险。
