| Objective: By collecting and collating the clinical data of elderly patients with osteoporotic fracture,this paper understands the situation of recurrent fracture in elderly patients with osteoporotic fracture and analyzes the possible risk factors of second fracture.in order to provide early prevention and intervention measures for elderly patients with primary fracture,so as to avoid the occurrence of recurrent fracture.Methods: This study retrospectively analyzed the clinical data of 1315 patients with osteoporotic fracture from January 2015 to December 2019 in the Department of Orthopaedics of a third-class hospital aged ≥ 60 years.By asking the medical history andviewing the results of relevant auxiliary examination,to find out whether the patients had a previous history of fracture,and then divided them into two groups:the first fracture group and the re-fracture group.Collect and sort out the basic information of the patients(including age,sex,body mass index((BMI)),systolic blood pressure,diastolic blood pressure,cause of fracture),blood biochemical indexes(including blood routine,fasting blood glucose,liver function index,renal function index,electrolyte,etc.),comorbidities and calculate Charlson complication index score,treatment(operation or conservative treatment,use of anti-osteoporosis drugs).Results:1.Comparison of basic information between the first fracture group and the re-fracture group: a total of 1315 patients who met the inclusion criteria were collected in this experiment.Including 1038(78.9%)in the first fracture group,266 males,accounting for 25.6%,and 772 females,accounting for 74.4%.The mean age of them was(73.3±9.01)years,and the re-fracture group was 277(21.1%),including 47 males,accounting for 17.0%.There were 230 women,accounting for 83.0%,with an average age of(76.2±8.11)years.The proportion of female patients in the re-fracture group was more than that in the first fracture group,and the age was higher than that in the first fracture group(P<0.05),while the body mass index((BMI))and diastolic blood pressure in the re-fracture group were lower than those in the first fracture group(P<0.05).There was no significant difference in systolic blood pressure between the two groups.2.The causes of fracture in the two groups: in the first fracture group,82.47% of the patients with initial fracture were caused by falls.The patients with low back pain,other causes(postural change,sprain)and bone fracture without inducement accounted for6.07%,6.26% and 5.20%,separately.Among the people in the re-fracture group who had fractures again,76.89% were caused by falls,and 6.86%,2.17% and 14.08% were caused by low back pain,other causes(postural changes,sprain)and no inducement,respectively.Fall was the most common risk factor for fracture in both the first fracture group and the re-fracture group.3.Comparison of blood biochemical indexes between the two groups: the values of hemoglobin,uric acid,albumin,fasting blood sugar,serum creatinine,total bilirubin,unconjugated bilirubin,conjugated bilirubin,aspartate aminotransferase(AST)and alanine aminotransferase(ALT)in the re-fracture group were lower than those in the first fracture group,while the value of blood phosphorus in the re-fracture group was higher than that in the first fracture group(P< 0.05).There was no significant difference in lactate dehydrogenase,alkaline phosphatase,serum potassium,serum sodium,serum calcium and serum magnesium between the two groups(P< 0.05).4.Comparison of co-disease and Charlson complication index scores between the two groups: in the re-fracture group,patients with chronic obstructive pulmonary disease((COPD)),Parkinson’s disease and peripheral vascular disease accounted for a high proportion(P<0.05).There was no obvious difference in hypertension,hyperlipidemia,coronary heart disease,arrhythmia,heart failure,diabetes,ophthalmopathy,dementia,cerebrovascular disease,liver disease,moderate and severe kidney disease,connective tissue disease and peptic ulcer between the two groups(P>0.05).Besides,the score of Charlson complication index in the re-fracture group was obviously more than that in the first fracture group(P < 0.05).5.Diagnosis and treatment of osteoporotic fracture in the two groups:(1)the overall diagnosis rate of osteoporosis in 1315 patients was 13%,and 1100 patients chose surgical treatment after fracture,accounting for 83.6% of the total.The basic treatment of osteoporosis after operation,such as calcium and Alfacalcidol,was 12.5% and 8.8%,separately.The utilization rate of bisphosphate drugs was 4.9%.(2)Among the people with first fracture,the diagnosis rate of osteoporosis was 10.2%.876 people chose surgical treatment after fracture,accounting for 84.4%.The utilization rates of calcium and Alfacalcidol were 10.1% and 6.8%,in several.The utilization rate of bisphosphate was 4.0%.(3)In people with secondary fractures,the diagnosis rate of osteoporosis was23.5%,224 people chose surgical treatment after fracture,accounting for 80.9%,the utilization rates of calcium and Alfacalcidol were 21.7% and 16.6% respectively,and the utilization rate of bisphosphate was 8.3%.6.Multiple logistic regression analysis showed that advanced age,high serum phosphorus,low hemoglobin,hypoglycemia,low creatinine,low albumin,and COPD were risk factors for recurrent fracture.Conclusion:1.Fall is the most common cause of osteoporotic fracture;the diagnosis and treatment rate of osteoporosis in both groups was low.2.Advanced age,high serum phosphorus,low hemoglobin,hypoglycemia,low creatine,low albumin and COPD were independent risk factors for recurrent fracture. |
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