Prediction of Fragility Fractures and Mortality in a Cohort of Geriatric Patients

IF 8.9 1区 医学 Journal of Cachexia, Sarcopenia and Muscle Pub Date : 2024-11-08 DOI:10.1002/jcsm.13631
Peter Dovjak, Bernhard Iglseder, Anna Rainer, Gregor Dovjak, Michael Weber, Peter Pietschmann
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Abstract

BackgroundRisk factors of refracture after fragility fractures include osteoporosis, female gender and advanced age among others. We hypothesized that the assessment of functionality, muscle health and nutrition status contribute to the risk prediction for further fractures and death.MethodsWe assessed 334 patients admitted to the department of acute geriatrics for sociodemographic data, bone fragility, selected laboratory tests, body composition and data on functionality using the comprehensive geriatric assessment. Patients had follow‐ups until the occurrence of further fractures or death. Dual‐energy X‐ray absorptiometry and pulse echo measurements were performed to assess bone mineral density. Fracture risk was assessed using the FRAX score and muscle strength according to published guidelines on sarcopenia.ResultsThe mean age was 81 years (70–95), and 82.3% (275/334) were women. An incidence of 10.4% (35/334) new fragility fractures was observed within 24 months, and the mortality rate was 12.2% (41/334). A significantly higher rate of further fractures was associated with lower BMI (body mass index) (HR 0.925, CI 0.872–0.98; p = 0.009), lower parathyroid hormone levels (HR 0.986, CI 0.973–0.998; p = 0.026) and with the diagnosis of osteoporosis (HR 2.546, CI 1.192–5.438; p = 0.016). No significant associations were present in patients with previous fractures, with higher age, higher FRAX scores, sarcopenia, in women, sarcopenic obesity, frail patients, lower grip strength, lower walking speed, lower Barthel index or lower DI (density index) values. The predictive power for further fractures was 10.7% higher adding osteosarcopenia, BMI and parathyroid hormone levels to standard assessment parameters osteoporosis, age and the status of previous fractures. Mortality was significantly higher with advanced age (HR 1.101, CI 1.052–1.151; p < 0.001), in men (HR 6.464, CI 3.141–13.305; p < 0.001), in smokers (p = 0.002), higher FRAX score (HR 1.039, CI 1.009–1.070; p = 0.010), lower renal function (HR 0.987, CI 0.976–0.997; p = 0.010), lower Tinetti test scores (HR 0.943, CI 0.900–0.987; p = 0.012), lower walking speed (HR 0.084, CI 0.018–0.382; p = 0.001), lower hand grip (HR 0.876, CI 0.836–0.919; p < 0.001) and lower Barthel index scores (HR 0.984, CI 0.971–0.997; p = 0.015).ConclusionsIn a cohort of geriatric patients, the addition of BMI, low parathyroid hormone levels and osteosarcopenia increases the predictive power for further fractures by 10.7%. These parameters are a valuable addition to the standard assessment parameters age and history of sustained fractures. Mortality is partly associated with potentially treatable functional parameters.
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预测老年患者群中的脆性骨折和死亡率
背景脆性骨折后再骨折的风险因素包括骨质疏松症、女性性别和高龄等。我们假设,对功能、肌肉健康和营养状况的评估有助于预测进一步骨折和死亡的风险。方法 我们对急性老年病科收治的 334 名患者进行了评估,包括社会人口学数据、骨脆性、部分实验室检查、身体成分以及使用老年病综合评估的功能数据。对患者进行了随访,直至发生进一步骨折或死亡。双能 X 光吸收测量法和脉冲回波测量法用于评估骨矿密度。结果平均年龄为 81 岁(70-95 岁),82.3%(275/334)为女性。24个月内新发生脆性骨折的比例为10.4%(35/334),死亡率为12.2%(41/334)。新骨折发生率明显较高与较低的 BMI(体重指数)(HR 0.925,CI 0.872-0.98;P = 0.009)、较低的甲状旁腺激素水平(HR 0.986,CI 0.973-0.998;P = 0.026)和骨质疏松症诊断(HR 2.546,CI 1.192-5.438;P = 0.016)有关。既往骨折患者、年龄较大、FRAX 评分较高、肌肉疏松症(女性)、肌肉疏松性肥胖、体弱患者、握力较低、步行速度较低、巴特尔指数较低或 DI(密度指数)值较低的患者均无明显相关性。在标准评估参数骨质疏松症、年龄和既往骨折情况的基础上,再加上骨质疏松症、体重指数和甲状旁腺激素水平,对进一步骨折的预测能力提高了 10.7%。高龄(HR 1.101,CI 1.052-1.151;p <;0.001)、男性(HR 6.464,CI 3.141-13.305;p <;0.001)、吸烟者(p = 0.002)、较高的 FRAX 评分(HR 1.039,CI 1.009-1.070;P = 0.010)、较低的肾功能(HR 0.987,CI 0.976-0.997;P = 0.010)、较低的 Tinetti 测试评分(HR 0.943,CI 0.900-0.987;P = 0.012)、行走速度较低(HR 0.084,CI 0.018-0.382;P = 0.001)、手握力较低(HR 0.876,CI 0.836-0.919;P <;0.001)和巴特尔指数得分较低(HR 0.984,CI 0.971-0.997;P = 0.015)。结论 在老年患者队列中,增加体重指数、甲状旁腺激素水平低和骨质疏松症会使进一步骨折的预测能力增加 10.7%。这些参数是对标准评估参数年龄和持续骨折史的重要补充。死亡率部分与潜在的可治疗功能参数有关。
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来源期刊
Journal of Cachexia, Sarcopenia and Muscle
Journal of Cachexia, Sarcopenia and Muscle Medicine-Orthopedics and Sports Medicine
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期刊介绍: The Journal of Cachexia, Sarcopenia, and Muscle is a prestigious, peer-reviewed international publication committed to disseminating research and clinical insights pertaining to cachexia, sarcopenia, body composition, and the physiological and pathophysiological alterations occurring throughout the lifespan and in various illnesses across the spectrum of life sciences. This journal serves as a valuable resource for physicians, biochemists, biologists, dieticians, pharmacologists, and students alike.
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