摘要
目的系统评价老年脆性骨折患者衰弱的患病率及二者的相关性。方法检索PubMed、Cochrane Library、Embase、Web of Science数据库中的老年脆性骨折患者衰弱患病率及相关性的观察性研究文献,检索时间为2000年1月至2024年5月。由两名研究者独立筛选文献、提取资料,并采用美国卫生保健质量和研究机构(Agencey for Healthcare Research and Quality,AHRQ)推荐的横断面研究质量评价量表和纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)评价纳入研究的偏倚风险。使用RevMan 5.4软件对患病率及骨折风险进行meta分析。结果共78篇文献报告了衰弱患病率,其中48篇报告了衰弱前期患病率。Meta分析结果显示,衰弱及衰弱前期整体患病率分别为34.5%(95%CI:30.7%~38.3%)、45.2%(95%CI:39.8%~50.6%)。亚组分析发现,年龄超过80岁(32.5%)、女性(35.7%)、来自于欧洲(37.9%)或亚洲(36.8%)的脆性骨折患者中,衰弱患病率更高。衰弱指数(Frail Index/Modified Frail Index,FI/mFI)(35.0%)和临床衰弱量表(The Clinical Frailty Scale,CFS)(35.3%)是使用最多的衰弱评估工具,两者得出的衰弱患病率相近。脆性骨折发生在髋部(36.3%)、脊柱(26.6%)和上肢(26.1%)的衰弱患病率各异,以髋部骨折部位最多。此外,有6篇文献探讨了衰弱与脆性骨折风险之间的关系,meta分析结果表明,与相对健康的患者相比,处于衰弱前期[比值比(odds ratio,OR)1.67,95%(CI:1.51~1.84)]或衰弱状态(OR:2.20,95%CI:1.82~2.63)的患者面临更高的骨折风险。结论尽管不同的定义和标准导致异质性较高,但目前研究结果依然明确证实了衰弱在老年脆性骨折群体中的高患病率,且其与骨折风险密切相关。因此,术前对衰弱的识别以及实施多学科综合管理,对降低衰弱发生率、延缓其发展进程,以及促进骨折患者的康复进程,均具有重要的现实意义。
Objective To summarize the prevalence of frailty in patients with fragility fracture and the associated risk factors for fragility fracture in elderly patients with frailty.Methods A comprehensive literature search was undertaken in PubMed,Web of Science,Embase,and The Cochrane Library,with the aim of identifying observational studies relevant to the prevalence and association of frailty in elderly patients with fragility fracture.The search encompassed a chronological range from January 2000 to May 2024.Two researchers independently screened the literature and extracted data,utilizing the cross-sectional study quality assessment scale recommended by the Agency for Healthcare Research and Quality(AHRQ)and the Newcastle-Ottawa Scale(NOS)to evaluate the risk of bias in the included studies.A Meta-analysis of prevalence and fracture risk was performed using RevMan 5.4 software.Results A total of 70 papers were included,with 78 reporting frailty prevalence,and 6 on fracture risk in patients with frailty.Meta-analysis results showed that the overall prevalence of frailty and prefrailty was 34.5%(95%CI:30.7%-38.3%)and 45.2%(95%CI:39.8%-50.6%),respectively.Subgroup analysis found that a higher prevalence of frailty among fragility fracture patients who were over 80 years age(32.5%),female(35.7%),and from European(37.9%)or Asian(36.8%).Frail Index/Modified Frail Index(FI/mFI)(35.0%)and The Clinical Frailty Scale(CFS)(35.3%)were the most commonly used frailty assessment tools,with similar prevalence rates.Fragility fractures occurred in the hip(36.3%),spine(26.6%),and upper limb(26.1%),with the most fractures occurring at the hip.Moreover,frailty(OR:2.20,95%CI:1.82-2.63)and prefrailty(OR:1.67,95%CI:1.51-1.84)were risk factors for fragility fracture.Conclusion Despite the high heterogeneity due to different definitions and criteria,the results clearly confirm the high prevalence of frailty in the elderly fragility fracture population and its strong association with fracture risk.Therefore,the recognition of frailty and the implementation of multidisciplinary integrated management before surgery are of great practical significance to reduce the incidence of frailty,delay its development and promote the rehabilitation process of fracture patients.
作者
王凌霄
张霞
彭洋
管丽娟
邓明洪
周莉华
周政
WANG Ling-xiao;ZHANG Xia;PENG Yang;GUAN Li-juan;DENG Ming-hong;ZHOU Li-hua;ZHOU Zheng(Geriatric Diseases Institute of Chengdu,Department of gerontology and geriatrics,Chengdu Fifth People's Hospital(The Second Clinical Medical College,Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine),Chengdu 611137,China)
出处
《中华骨质疏松和骨矿盐疾病杂志》
北大核心
2025年第2期158-167,共10页
Chinese Journal Of Osteoporosis And Bone Mineral Research
基金
成都市科学技术局重大项目(NO.2022-YF09-00014-SN)
成都中医药大学学科人才科研提升计划(XJ2023013201)。
关键词
衰弱
脆性骨折
骨折风险
患病率
系统评价
frailty
fragility fracture
fracture risk
prevalence
systematic review
