背景:身体功能是骨折的重要危险因素。以前的研究发现,不同的物理测试(例如,单腿站立[OLS]和定时并走[TUG])预测骨折风险。本研究旨在确定哪种身体功能测试是骨折风险的最佳独立预测因子。以及用于骨折风险评估(FRAX)和骨矿物质密度(BMD)的临床风险因素(CRF)。
方法:总共,包括3028名老年妇女中的2321名妇女,年龄77.7±1.6(平均值±SD),在Sahlgrenska大学医院的骨骨折风险前瞻性评估研究中,所有身体功能测试的数据均完整,并纳入分析.在基线,手握力,OLS,TUG,进行了步行速度和椅子站立测试。所有意外骨折均通过X线检查或病历检查证实,随后被归类为严重骨质疏松性骨折(MOFs)。髋部骨折和任何骨折。进行多变量Cox回归(风险比[HR]和95%置信区间[CI])分析,并调整年龄,体重指数(BMI),FRAXCRFs,股骨颈BMD和所有身体功能测试单独和同时作为预测因子。还进行了接收器工作特征(ROC)分析以及精细和灰色分析,以研究身体功能与意外骨折之间的关联。
结果:OLS是唯一与任何骨折风险增加显著且独立相关的身体功能测试(HR1.13[1.04-1.23]),MOF(HR1.15[1.04-1.26])和髋部骨折(HR1.34[1.11-1.62])。调整年龄,BMI,CRF和股骨颈BMD并未实质性改变这些关联。OLS的ROC分析,加上年龄,BMI,股骨颈BMD和CRF,任何骨折的曲线下面积值0.642、0.647和0.732,MOF和髋部骨折,分别。在考虑死亡风险竞争的分析中,OLS是唯一与骨折结果一致相关的身体功能测试(任何骨折的亚风险比[SHR]1.10[1.01-1.19],对于MOF,SHR为1.11[1.00-1.22],对于髋部骨折,SHR为1.25[1.03-1.50])。在所有Cox回归模型以及Fine和Gray分析中,步行速度仅与髋部骨折的风险独立相关。
结论:在五项身体功能测试中,OLS与所有骨折结局独立相关,即使在考虑到死亡的竞争风险之后,表明OLS是预测老年女性骨折风险的最可靠的身体功能测试。
BACKGROUND: Physical function is an important risk factor for fracture. Previous studies found that different physical tests (e.g., one-leg standing [OLS] and timed up and go [TUG]) predict fracture risk. This study aimed to determine which physical function test is the most optimal independent predictor of fracture risk, together with clinical risk factors (CRFs) used in fracture risk assessment (FRAX) and bone mineral density (BMD).
METHODS: In total, 2321 women out of the included 3028 older women, aged 77.7 ± 1.6 (mean ± SD), in the Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures study had complete data on all physical function tests and were included in the analysis. At baseline, hand grip strength, OLS, TUG, walking speed and chair stand tests were performed. All incident fractures were confirmed by X-ray or review of medical records and subsequently categorized as major osteoporotic fractures (MOFs), hip fractures and any fracture. Multivariate Cox regression (hazard ratios [HRs] and 95% confidence intervals [CIs]) analyses were performed with adjustments for age, body mass index (BMI), FRAX CRFs, femoral neck BMD and all physical function tests as predictors both individually and simultaneously. Receiver operating characteristic (ROC) analyses and Fine and Gray analyses were also performed to investigate associations between physical function and incident fractures.
RESULTS: OLS was the only physical function test to be significantly and independently associated with increased risk of any fracture (HR 1.13 [1.04-1.23]), MOF (HR 1.15 [1.04-1.26]) and hip fracture (HR 1.34 [1.11-1.62]). Adjusting for age, BMI, CRFs and femoral neck BMD did not materially alter these associations. ROC analysis for OLS, together with age, BMI, femoral neck BMD and CRFs, yielded area under the curve values of 0.642, 0.647 and 0.732 for any fracture, MOF and hip fracture, respectively. In analyses considering the competing risk of death, OLS was the only physical function test consistently associated with fracture outcomes (subhazard ratio [SHR] 1.10 [1.01-1.19] for any fracture, SHR 1.11 [1.00-1.22] for MOF and SHR 1.25 [1.03-1.50] for hip fracture). Walking speed was only independently associated with the risk of hip fracture in all Cox regression models and in the Fine and Gray analyses.
CONCLUSIONS: Among the five physical function tests, OLS was independently associated with all fracture outcomes, even after considering the competing risk of death, indicating that OLS is the most reliable physical function test for predicting fracture risk in older women.