Vestergaard P, Krogh K, Rejnmark L, Mosekilde L
Aarhus Bone and Mineral Research Group, Department of Endocrinology and Metabolism, Denmark.
Spinal Cord. 1998 Nov;36(11):790-6. doi: 10.1038/sj.sc.3100648.
To study fracture rates and risk factors for fractures in patients with spinal cord injuries.
A self-administered questionnaire was mailed to 646 members of the Danish Paraplegic Association and 1000 randomly selected normal controls. 438 patients (309 males, 129 females, 67.8%) and 654 controls (332 males, 322 females, 65.4%) returned the questionnaire. Median age in patients was 42, range 10-80 years, and in controls 43, range 19-93 years (2p = 0.25).
The crude fracture rate was 2% per year in patients and 1% per year in controls (RR = 2.0, P < 0.001). Low-energy fractures were much more prominent in patients (19.0% of all fractures) than in controls (1.4%, P < 0.001). The fracture rate did not differ before the injury but increased after the injury to a constant level from the third year and forward. Fractures of the lower extremities were more prominent in patients than controls (femurs: RR = 23.4, P < 0.001, lower legs: RR = 5.2, P < 0.001, feet/toes: RR = 2.4, P = 0.006) while fractures of the forearms (P < 0.001) and clavicles (P = 0.03) were absent among patients. Fractures were more frequent in female patients (RR = 1.6, P = 0.008) and in male patients with a family history of fractures (RR = 2.0, P = 0.004).
Low-energy fractures especially of the lower extremities are frequent in spinal cord injury patients and especially among female patients. The forearms seem protected from fractures.
研究脊髓损伤患者的骨折发生率及骨折危险因素。
向646名丹麦截瘫协会成员和1000名随机选取的正常对照者邮寄了一份自填式问卷。438例患者（309例男性，129例女性，67.8%）和654例对照者（332例男性，322例女性，65.4%）返回了问卷。患者的年龄中位数为42岁，范围为10 - 80岁，对照者的年龄中位数为43岁，范围为19 - 93岁（P = 0.25）。
患者的粗骨折发生率为每年2%，对照者为每年1%（相对危险度=2.0，P < 0.001）。低能量骨折在患者中（占所有骨折的19.0%）比对照者（1.4%，P < 0.001）更为突出。骨折发生率在受伤前无差异，但受伤后从第三年起增加并维持在一个稳定水平。下肢骨折在患者中比对照者更为突出（股骨：相对危险度=23.4，P < 0.001；小腿：相对危险度=5.2，P < 0.001；足/趾：相对危险度=2.4，P = 0.006），而患者中没有前臂骨折（P < 0.001）和锁骨骨折（P = 0.03）。女性患者骨折更为频繁（相对危险度=1.6，P = 0.008），有骨折家族史的男性患者骨折也更为频繁（相对危险度=2.0，P = 0.004）。
低能量骨折，尤其是下肢骨折，在脊髓损伤患者中很常见，在女性患者中尤为如此。前臂似乎不易发生骨折。
