FRAX骨折風險工具評估成年智能障礙者未來十年骨折風險與相關因素

Assessment of Hip and Major Osteoporotic Fracture and Correlates of Adults with Intellectual Disabilities by Using the FRAX Tool

智能障礙者因老化會導致許多疾病的發生，骨質疏鬆症為普遍發生的疾病，也是後續造成骨折的風險之一。本研究主要目的乃利用中文化的FRAX®骨折風險評估工具，來篩檢智能障礙者未來十年骨折的風險與相關因素分析。本研究以橫斷性設計與結構性問卷進行調查|立意取樣選取7家身心障礙福利機構18歲以上之智能障礙者為評估對象，透過主要照顧者的觀點來評估智能障礙者的骨折發生危險機率。主要照顧者閱讀研究說明與簽署研究調查書面同意書後，填寫調查問卷。本研究資料收集方式以郵寄至身心障礙福利機構，共計發放965份問卷，實際回收946份有效問卷，回收率為98%。研究結果發現，FRAX®10年骨折風險評估部分，智能障礙者之主要骨鬆性骨折，平均機率為1.98%，以低風險組（＜10%）為最多，有928人（98.7%），其次為中度風險（10-19%），有10人（1.1%），高度風險則有2人（0.2%）。髖骨骨折平均機率0.31%，以低風險組（＜1.5%）為最多，有899人（95.6%），其次為中度風險（1.5-3.0%），有29人（3.1%），高度風險則有12人（1.3%）。而在骨折風險之多變項分析結果顯示男性比女性罹患骨質疏鬆性骨折的風險是較低，行為能力部分受限者其骨質疏鬆性骨折風險是高於其他群體。而在髖骨骨折風險之多變項分析顯示：男性比女性罹患髖骨骨折風險機率是較低的，年齡大於等於50歲以上者其髖骨骨折風險是高於40歲以下年齡層。研究建議應避免智能障礙群體的發生骨折風險因子，並加強骨質密度狀況、身體活動與健康狀況等之監測，並適當的增加日照時間，這些項目是機構可以推動的健康促進活動，藉以保健該群體的骨質健康與預防骨質疏鬆症，進而避免骨折的發生。

Aging disorders can cause many diseases in people with intellectual disabilities, and osteoporosis is one of common aging diseases and will result in subsequent fractures. The main purpose of this study is to use the Chinese version of FRAX fracture risk assessment tool to screen for the risk and correlates of fractures of people with intellectual disabilities. Purposive sampling was employed to select seven disability welfare institutions in this study. Those persons with intellectual disabilities over 18 years of age were recruited and their main caregivers provide the proxy reports of the questionnaire. After reading the study description and the caregiver signing the research survey written consent form, and then fills out the questionnaire (n=946). The results of the study found that in the FRAX 10-year fracture risk assessment section, the average probability of major osteoporotic fractures in persons with intellectual disabilities was 1.98%, with the lowest risk group (＜10%) as the most common, with 928 (98.7%), followed by moderate risk (10-19%), there are 1.1%, and for high risk group (0.2%). The average probability of hip fracture was 0.31%, with the lowest risk group (＜1.5%) as the most frequent group, with 899 people (95.6%), followed by moderate risk (1.5-3.0%), with 3.1%, and high risk group (1.3%). The results of multivariate analysis showed that factors of gender and mobility ability were associated with osteoporotic fracture risk, and factors of gender and age associated with the risk of hip fracture. Research suggests that the risk factors for fractures in groups with intellectual disabilities should be avoided, and the monitoring of bone density, physical activity and health status should be strengthened, and the duration of sunshine should be appropriately increased. These health promotion activities can be promoted by institutions to care for this group of bone health and prevention of osteoporosis, thereby avoiding the occurrence of fractures.