老年人骨折部位對生活品質影響之先驅性研究

A Pilot Study of the Impact of Fracture Sites on Quality of Life among Elderly

目的：台灣人口結構迅速老化，骨鬆與骨折的發生率快速上升。藉由骨折史與骨折部位對生活品質影響之分析，達到骨鬆防治與骨折預防之目的。

方法：本研究於2020年2月至2020年8月間，針對至成大醫院家庭醫學部骨質疏鬆特別門診就診之65歲以上骨質缺乏或骨質疏鬆症之病人進行問卷調查，共收集有效個案83位。以EuroQol 5-dimentional questionnaire (EQ-5D)及Visual analogue scale問卷評估骨質疏鬆症病人之生活品質及自評健康狀況，藉由時間交換法(time trade-off)加權得到EQ-5D 指數(EQ-index)，分析有無骨折病史以及不同骨折部位對於生活品質分數的影響，同時比較不同骨折對EQ-5D index不同面向及自評健康狀況之影響。

結果：在83位受檢者中，平均年齡為73.5 ± 6.2歲，其中女性佔94.0%。無骨折病人共33位，曾脊椎骨折共41位，曾髖骨骨折共6位，其他部位骨折共6位。無骨折病史的病人平均EQ-5D index是0.72±0.18分，曾骨折之病人平均的EQ-5D index是0.55±0.27分，在統計學上有顯著差異(p=0.001)。無骨折病史的病人平均VAS分數是71.7±10.87分，曾骨折之病人平均VAS分數是64.00±14.11分，兩者在統計學上亦有顯著差異(p=0.010)。不同骨折部位中，曾髖骨骨折及曾脊椎骨折之平均EQ-5D分數分別為0.37±0.21分及0.55±0.28分；進一步分析EQ-5D五個面向，在無骨折的病人中，81.8%可以四處走動；而曾髖骨骨折及曾脊椎骨折病人可以四處走動的比例分別是0%及44.7%。

結論：在老年族群中，曾經發生骨折之病人，其生活品質比無骨折病人低。在不同骨折部位中，又以曾髖骨骨折之病人受到的影響最大，特別是行動以及日常活動之影響最為嚴重。

 

Objectives: Due to growing elderly population, the prevalence of osteoporosis and fractures in Taiwan has increased rapidly. The aim of the study is to analyze the impact of fracture site on the quality of life among the elderly population for assisting in the prevention of osteoporosis and fracture.

Methods: We enrolled the subjects aged ≥ 65 years old and diagnosed with osteoporosis in the Family Medicine Department at National Cheng Kung University Hospital from February to August 2020. Each subject completed a structured questionnaire with the guidance of an administrative staff well-trained in conducting face-to-face interviews. After those with missing BMD and fracture data were excluded, a total of 83 subjects were recruited for final analysis. EuroQol 5-dimentional questionnaire (EQ-5D) and visual analogue scale (VAS) were used to assess quality of life, and the EQ-5D index was obtained using the time trade-off method. The study examined not only the impact of fracture on quality of life but also the impact of different fracture sites on the EQ-5F index.

Results: The 83 enrolled subjects reported an average age of 73.5 ± 6.2 years old, and 94% of them were females. 33 of the subjects had no fracture history, while 41 had spine fracture, 6 had hip fracture, and 6 had fractures at other sites. The average EQ-5D index without/with fracture history read 0.72±0.18 and 0.55±0.27 respectively (p=0.001). The average VAS without/with fracture history read 71.70±10.87 and 64.00±14.11 respectively (p=0.01). In addition, the average EQ-5D index in hip and spine fracture read 0.37±0.21 and 0.55±0.28 respectively. It was further observed that 81.8% of the no-fracture subjects were capable of walking around. However, 0% and 44.7% of subjects with hip and spine fracture were unable to do so even if the fractures had happened over 5 years.

Conclusion: Compared with their no-fracture counterparts, elderly individuals experiencing fractures pale in terms of quality of life. Furthermore, hip fracture appears to exert the most profound impact on the quality of life in the elderly, especially in mobility and daily activity.