PDF(Pubmed)
Abstract：
Apolipoprotein ɛ4 (APOE ɛ4) may be a genetic risk factor for reduced bone mineral density (BMD) and muscle function, which could have implications for fall and fracture risk. We examined the association between APOE ɛ4 status and long-term fall- and fracture-related hospitalization risk in older women. A total of 1 276 community-dwelling women from the Perth Longitudinal Study of Aging Women (mean age ± SD = 75.2 ± 2.7 years) were included. At baseline, women underwent APOE genotyping and detailed phenotyping for covariates including prevalent falls and fractures, as well as health and lifestyle factors. The association between APOE ɛ4 and fall-, any fracture-, and hip fracture-related hospitalizations, obtained over 14.5 years from linked health records, was examined using multivariable-adjusted Cox-proportional hazard models. Over 14.5 years, 507 (39.7%) women experienced a fall-related hospitalization and 360 (28.2%) women experienced a fracture-related hospitalization, including 143 (11.2%) attributed to a hip fracture. In multivariable-adjusted models, compared to noncarriers, APOE ɛ4 carriers (n = 297, 23.3%) had greater risk for a fall- (hazard ratio [HR] 1.48, 95% CI: 1.22-1.81), fracture- (HR 1.28, 95% CI: 1.01-1.63), or hip fracture-related hospitalization (HR 1.83, 95% CI: 1.29-2.61). The estimates remained similar when specific fall and fracture risk factors (fear of falling, plasma 25-hydroxyvitamin D, grip strength, timed up-and-go, hip BMD, vitamin K status, prevalent diabetes, HbA1c, cholesterol, and abbreviated mental test score) were added to the multivariable model. In conclusion, APOE ɛ4 is a potential risk factor for fall- and fracture-related hospitalization in community-dwelling older women. Screening for APOE ɛ4 could provide clinicians an opportunity to direct higher-risk individuals to appropriate intervention strategies.
摘要：
载脂蛋白4可能是降低骨密度（BMD）和肌肉功能的遗传危险因素，这可能对跌倒和骨折风险有影响。我们研究了老年女性APOEä4状态与长期跌倒和骨折相关住院风险之间的关系。纳入了来自珀斯老龄妇女纵向研究的1276名社区居住妇女（平均年龄±SD=75.2±2.7岁）。在基线,女性接受了APOE基因分型和详细的表型分析，包括普遍的跌倒和骨折，以及健康和生活方式因素。APOE通4与fall-，任何裂缝-，和髋部骨折相关的住院治疗，从相关的健康记录中获得超过14.5年，使用多变量调整后的Cox比例风险模型进行检查。超过14.5年,507名（39.7%）女性因跌倒住院，360名（28.2%）女性经历了骨折相关的住院，包括143（11.2％）归因于髋部骨折。在多变量调整模型中，与非运营商相比，APOE^4携带者(n=297，23.3%)有更大的跌倒风险-(HR1.4895CI1.22-1.81)，骨折（HR1.28，95CI1.01-1.63）或髋部骨折相关住院（HR1.8395CI1.29-2.61）。当特定的跌倒和骨折风险因素(害怕跌倒，血浆25-羟基维生素D，握力,定时和去，髋部BMD,维生素K状态，普遍存在的糖尿病，HbA1c,胆固醇,缩写的心理测验评分)被添加到多变量模型中。总之,在社区居住的老年妇女中，APOE4是与跌倒和骨折相关的住院的潜在危险因素。APOE4的筛查可以为临床医生提供一个将高风险个体引导到适当干预策略的机会。
