Determinants of Recovery Following Hip Fracture

髋部骨折后恢复的决定因素

• 批准号: 6794754
• 负责人: JAY MAGAZINER
• 金额: $ 18.92万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6794754
• 关键词: 1,25 dihydroxycholecalciferol; 25 hydroxycholecalciferol; aging; alkaline phosphatase; biomarker; bone density; bone metabolism; collagen; densitometry; exercise; female; frail elderly; hip fractures; human old age (65+); human subject; human therapy evaluation; medical rehabilitation related tag; musculoskeletal disorder therapy; osteoblasts; osteocalcin; osteoclasts; parathyroid hormones; patient oriented research; procollagen; rehabilitation

Hip fracture is a major public health problem. Results from our previous work demonstrate a 4.6 percent loss of femoral neck bone mineral density (BMD) during the year following a hip fracture; this dramatic loss in BMD is accompanied by notable changes in markers of bone metabolism. The parent project to the proposed ancillary study is a randomized controlled trial of a home-based exercise program intended to minimize losses in BMD, muscle and function following a hip fracture. The proposed ancillary study will evaluate markers of bone metabolism and selected regulating hormones in hip fracture patients who are participating in this intervention study in order to gain a better understanding of the mechanism by which exercise affects bone health during the year following a hip fracture. These markers and hormones also will be evaluated over a one year period in a matched group of non-fracture controls to establish expected levels and changes in markers of bone metabolism among a frail group of older persons who also have low BMD. The primary aims of the proposed study are: 1) to evaluate the role of exercise on bone metabolism following hip fracture by comparing bone metabolism during the year after hip fracture in patients randomized to a home-based exercise intervention with patients assigned to usual care, and 2) to separate the effects of hip fracture on bone metabolism from those of aging in similar persons with low BMD by comparing bone metabolism in hip fracture patients receiving usual care with bone metabolism in a matched group of non-fracture controls. These issues will be addressed using data from 170 female hip fracture patients age 65 plus (100 enrolled in the parent study, and an additional 70 hip fracture patients to be recruited for this ancillary study), and 85 age- and mobility-matched non- fracture controls with BMD Less than 0.82g/cm2. Patients are randomized to a year-long, home-based exercise program to begin when post-acute therapy ends, or usual care. As part of the parent study, 100 patients are having BMD measured during their hospital stay, and again at 2, 6, and 12 months, and blood samples for these 100 patients are being taken, processed, and stored. For the ancillary study, this protocol will be extended to include 70 additional hip fracture patients and 85 non- fracture controls, the latter of which will be measured at point of enrollment and 12 months later. For this ancillary study, all blood samples (i.e., those collected on 100 patients in the parent study and those collected on 70 patients and 85 non- fracture controls in the ancillary study) will be assayed to determine levels of four markers of bone metabolism and three regulating hormones. Information of this type will be useful developing interventions to improve bone health and maximize recovery.

髋部骨折是一个主要的公共卫生问题。 我们以前的工作的结果表明，在髋部骨折后的一年中，股骨颈部骨矿物质密度（BMD）损失了4.6％。 BMD中的这种戏剧性损失伴随着骨代谢标记的显着变化。 拟议的辅助研究的父项目是一项基于家庭运动计划的随机对照试验，该试验旨在最大程度地减少髋部骨折后BMD，肌肉和功能的损失。 拟议的辅助研究将评估参加此干预研究的髋部骨折患者中骨骼代谢的标志，并选择调节激素，以便更好地了解髋部骨折后运动在一年中影响骨骼健康的机制。 这些标记和激素还将在一年的一年中评估一组匹配的非裂缝对照组，以建立预期水平和骨代谢标记的变化，而BMD也很低的老年人组中的骨骼代谢。拟议的研究的主要目的是：1）评估髋部骨折后锻炼对骨骼代谢的作用，通过比较髋部骨折后的骨骼代谢在患者中随机分为家庭运动干预的患者与分配给常规护理的患者的患者，以及2），以分离髋部对骨骼骨折的影响与骨骼的影响与骨骼的影响分开，以使骨骼的影响与骨骼衰减的人分离，而骨骼代谢的人则与骨骼的疾病相比，骨骼的影响与骨骼的疾病相似。在一组匹配的非骨折对照组中接受骨代谢的常规护理。这些问题将使用来自65岁以上的170名女性髋部骨折患者的数据（父母研究招募100例），另外70名髋部骨折患者将用于这项辅助研究），而BMD小于0.82g/cm2，将招募85名年龄和移动性的非骨折对照。 患者被随机分配为一年的家庭运动计划，急性治疗结束或通常的护理时开始。 作为父母研究的一部分，100例患者在住院期间测量了BMD，并在2、6和12个月再次测量了BMD，并且正在服用，处理和存储这100名患者的血液样本。 对于辅助研究，该方案​​将扩展到包括70名髋部骨折患者和85例非骨折对照，后者将在入学点和12个月后进行测量。 在这项辅助研究中，所有血液样本（即，在父母研究中收集的100例患者和辅助研究中的70例患者和85例非骨折对照的血液样本）都将分析以确定骨代谢的四个标记和三种调节激素的标记水平。 这种类型的信息将是有用的开发干预措施，以改善骨骼健康并最大程度地恢复。