Analysis Of Risk Factors For Osteoporotic Re-Fractures In The Elderly

Objective:To evaluate the risk factors for osteoporotic re-fractures in the elderly and provide an objective basis for early and accurate prediction of re-fractures through collecting and analysing clinical data of osteoporotic fractures patients in a third grade A hospital.The aim is to find appropriate interventions to reduce the occurrence of re-fracture.Methods:A retrospective case-control study was used in this paper.Including 803 osteoporotic fracture patients aged 60 years or older,those who were hospitalized in orthopaedics department of a third grade A hospital from January 2015 to December2016.According to the history of fragile fracture in the past,the patients were divided into the first time fracture group(Group 1)and the re-fracture group(Group 2).We collected data of two groups of patients,such as general information(sex,age,systolic blood pressure,diastolic blood pressure,body mass index(BMI),pathogenetic season,fracture site),laboratory index(hemoglobin,serum albumin,serum alkaline phosphatase,serum creatinine,serum calcium,serum phosphorus,blood glucose),comorbid medical conditions,diagnosis and treatment of osteoporosis in hospital.Statistical analysis was performed using the SPSS version 22 software program.Mann-Whitney U-test and ?2 test were used for statistical differences between the two groups.To investigate the predisposing risk factors of re-fracture with Logistic regression.Result:1.Among 803 osteoporotic fractures patients,there were 668 patients(83.2%)in Group 1(the first time fracture group)and 135 patients(16.8%)in Group 2(the re-fracture group).The patients in Group 1,with an average age(73.96 ± 9.35)years old,including 481 women(72.0%)and 187 men(28.0%).The patients in Group 2,with an average age of(76.69 ± 8.12)years old,including 111 women(82.2%)and 24 men(17.8%).The proportion of women in Group 2 was higher than that in Group 1(P=0.01),and patients of Group 2 were older than that of Group 1(P=0.001).The BMI of the patients in Group 1 was higher than that of Group 2(P=0.038).There were no significant differences between the two groups with systolic blood pressure and diastolic blood pressure.The incidence rates of Group 1 in spring,summer,autumn and winter were 25.6%,25.3%,20.8% and 28.3% respectively.The incidence of Group 2 in spring,summer,autumn and winter were 20.7%,24.4%,31.9% and 23.0% respectively.Whether Group 1 or Group 2,the spine and hip were the most frequent sites of fracture.2.The levels of hemoglobin,serum albumin and serum creatinine in Group 2 were lower than those Group 1(P < 0.05).There were no significant difference in serum alkaline phosphatase,serum calcium,serum phosphorus and blood glucose between the two groups.3.The proportion of patients with coronary heart disease,cerebral infarction,chronic obstructive pulmonary disease and eye diseases in Group 2 was higher than that in Group 1(P<0.05).There were no significant difference between the two groups with hypertension,diabetes mellitus and arrhythmia.4.Logistic regression analysis reveals that female,advanced age,low body mass index,coronary heart disease,cerebral infarction and COPD were risk factors for re-fracture in the eldly.5.During the hospitalization period,the overall diagnostic rate of osteoporosis was8.1%,the basic treatment rate of osteoporosis(calcium and/or vitamin D)was 11.6%and the anti-osteoporosis treatment rate(bisphosphonate and/or calcitonin and so on)was 6.0%.In Group 1,the diagnostic rate of osteoporosis was 6.9%,the basic treatment rate of osteoporosis was 9.9% and the anti-osteoporosis treatment rate was 4.5%.In Group 2,the diagnostic rate of osteoporosis was 14.1%,the basic treatment rate of osteoporosis was 20.0% and the anti-osteoporosis treatment rate was 13.3%.Conclusion:1.Comparing with Group 1,women in Group 2 have a higher proportion.The average age of patients in Group 2 is older than that in Group 1.BMI,hemoglobin,serum albumin and serum creatinine of patients in Group 2 are lower than that in Group1.2.Female,advanced age,low body mass index,coronary heart disease,cerebral infarction and COPD are risk factors for re-fracture.3.During hospitalization,the rate of diagnosis and treatment of osteoporosis is low in both two groups.