Hohhot Elderly Hip Fracture Epidemiological Investigation And Its Related Research

Elderly hip fracture is a worldwide public health problem. Hip fracture is the most severe type of osteoporotic fractures, because of its high cost, high mortality and high morbidity. With the aging of the population increased, their impact on social problems becoming more severely. Nowadays, there is still lack of relevant information about elderly hip fracture in Huhhot area. This study was designed to investigate the epidemiology of elderly hip fracture and its association with traditional Chinese medicine constitution types and estrogen receptor gene polymorphisms in Huhhot area.Part One Retrospective study of elderly inpatients with hip fracture in Huhhot areaObjective:By a retrospective study among the elder people with elderly hip fracture in Huhhot area, we aim at elucidating the epidemiological characteristics of elderly hip fracture in this area which can provide theoretical basis for the treatment or prevention of elderly hip fracture.Methods:We collected 986 elderly hip fracture cases treated in six tertiary hospitals from January 2005 to December 2008. We filled the corresponding information in hip fracture survey form and analyzed the trends of hip fracture. Epidemiologic features and correlation factors were compared and analyzed between femoral neck fracture and femoral inter-trochanter fracture. At the same time, the trends of osteoporosis diagnosis and treatment in hip fracture were analyzed.Results:(1) We found that cases of elderly hip fracture were increasing during last four years, the cases in female of over 60 years old were significantly higher than that in male (372 for males,614 for females), and got to its climax between age group 70 and 89 (accounting for 70.18% of its total). There is significant area characteristic of elderly hip fracture in Huhhot.(2) We found that cases of osteoporosis diagnosis were in increased trend during last four years, but there were lots of missed diagnosis cases. Although the anti-osteoporosis treatment of cases increased year by year, but there are obvious blindness and randomness.Conclusions:(1) We should target at Hohhot elderly hip fracture characteristics, strengthening regional population of hip fracture, in particular, preventing falls and osteoporosis(2) Medical diagnosis and treatment of osteoporosis in tertiary hospitals in Huhhot was insufficient. The continuing education for orthopaedic surgeons in hospitals should be strengthen to realize that surgeons will hold a more active attitude, choose a reasonable anti-osteoporosis therapy plan.Part Two Study on relationships between TCM constitution types and bone mineral density in elderly hip fracturesObjective:With study on distributing regularity of traditional Chinese medicine (TCM) constitution in elderly inpatients with hip fracture living in Huhhot and the relationship with bone mineral density (BMD), to offer theory evidence for fitting relative high-risk group of elderly hip fracture. As a result, we can provide appropriate interventions to prevent the occurrence of elderly hip fractures.Methods:156 elderly hip fracture patients and 156 non-fracture controls were selected. They were assessed according to the diagnosis standard of constitution of TCM and were measured the BMD of abdominal vertebra respectively.Results:According to TCM constitution, the ratio of constitution type in two groups had statistical difference (P< 0.05), and the constitution of Qi deficiency, yang deficiency, ying deficiency and blood stasis of elderly hip fracture patients were higher in ratio than normal population. They were 21.15%, 14.74%,15.39%,16.03%. BMD was lower in elderly hip fracture than normal population at Lumbar Spine 2-4.Conclusions:Qi-deficiency type, yang-def iciency type, ying-def iciency type, blood-stasis type and phlegm-damp type are the main constitutional influential factors in patients with elderly hip fracture patients. There were close relationship between constitution types and BMD.Part three Case-control study on ER a gene polymorphisms of elderly male inpatients with hip osteoporotic fractureObjective:To investigate the relationship between ERαgene polymorphisms and osteoporosis in Han elderly male inpatients with hip fracture at Huhhot area. Methods:By a case-control study, We collected 128 Han elderly male inpatients with hip osteoporotic fracture and 128 men without osteoporosis.They were measured by DEXA. XbaⅠand PvuⅡrestriction fragment length polymorphism (RFLP) of ERαwere analyzed by PCR-RFLP. The relationship between polymorphism of the estrogen receptor a gene and osteoporosis was evaluated. The RFLP was represented as Pp (PvuⅡ) and Xx (XbaⅠ).Results:In the group of osteoporosis, frequencies of ERaPvuⅡgenotype PP, Pp and pp were 7.8%,42.2% and 50.0% respectively. In control group frequencies were 13.3%,53.9% and 32.8% respectively. ANOVA indicated that there was difference in the distribution of genotype and allele frequency between osteoporosis group and control group (P<0.05). In the group of osteoporosis, frequencies of ERαXbaⅠgenotype XX, Xx and xx were 4.7%,44.5% and 50.8% respectively. In control group, frequencies were 3.1%,39.1% and 57.8% respectively. ANOVA indicated that there was no difference in the distribution of genotype and allele frequency between osteoporosis group and control group (P>0.05).Conclusion:Hardy-Weinberg equilibrium was evident for ER a gene polymorphisms. The results suggested that there was a correlation between ER a gene PvuⅡRFLP and osteoporosis in Han elderly men at Huhhot area. Elderly hip fracture may be associated with ERαgene polymorphism.