노년층 고관절부 골절과 골다공증의 상관 관계
The Relationship of Osteoporosis and Hip Fractures in Elderly Patients
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목적: 노년층 고관절부 골절 환자의 골 밀도를 측정하여 골다공증과 노년층 고관절부 골절의 상관 관계를 알아보고 골절 예방을 위한 골다공증 약물 치료 기준점을 제시하고자 하였다. 대상 및 방법: 2004년 2월부터 2007년 4월까지 고관절부 골절로 내원한 환자 중 65세 이하와 대사성 질환이나 병적 골절 등을 제외한 172예를 대상으로 대퇴 근위부와 요추부의 골밀도를 측정하여 골절과의 상관관계 및 골절 위험 한계치를 산출하였다. 결과: 평균 골 밀도는 대퇴부 T-score -2.63, 요추부 -2.95로 정상인에 비해 저하되었고 경부 골절 군의 요추부 T-score는 - 2.86, 전자간 골절 군 -3.22로 전자간 골절에서 낮게 나타났다(p=0.04). 경부 골절 군에서 비전위 골절과 전위 골절의 요추부 T-score는 -2.21, -3.10 (p=0.041), 대퇴부 -2.29, -2.76 (p=0.012)로 각각 전위골절에서 낮았다. 안정성 및 불안정성 대퇴 전자간 골절사이에는 유의한 차이가 없었다. 고관절부 골절 위험 한계치는 요추부 T-score -1.29, 대퇴 근위부 -1.15였다. 결론: 노년층 고관절부 골절 예방을 위해서는 T-score가 -1.5 이하부터 골다공증의 적극적인 치료가 요할 것으로 사료되었다.
Abstract
Purpose: We measured the BMD (bone mineral density) of elderly patients with hip fracture in order to understand the relationship between osteoporosis and hip fracture, and also to suggest a reference point for starting an osteoporosis treatment program. Materials and Methods: From February 2004 to April 2007, we investigated 172 elderly hip fracture patients. Their BMD was checked by DEXA (Hologic QDR-4500w, S/N 49492) at the proximal femur and at the 1st to 4th lumbar vertebrae. The average T-score of the hip fracture patients and the fracture threshold was calculated. Results: The average BMD of the patients with hip fracture was -2.63 of the T-score in the proximal femur and - 2.95 of that in the lumbar vertebrae. The BMD in the patients with intertrochanteric fracture was significantly decreased compared to that of femur neck fracture (p=0.04, 0.19). For the femur neck fracture patients, the BMD of the displaced group was decreased compared to that of the undisplaced group (p=0.04, 0.01). The fracture threshold was -1.29 of the T-score in lumbar vertebrae, and the fracture threshold was -1.15 in the proximal femur. Conclusion: The BMD in elderly patients with hip fracture was significantly decreased compared that of normal people. For the prevention of hip fracture in elderly patients, we propose that the aggressive treatment of osteoporosis should be started for patients with a T-score less than -1.5.
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