今日の臨床サポート

大腿骨頚部骨折(大腿骨頚部内側骨折)

著者: 加来信広 大分大学医学部整形外科学

監修: 酒井昭典 産業医科大学 整形外科学教室

著者校正/監修レビュー済:2020/05/14
参考ガイドライン:
  1. 日本整形外科学会:大腿骨頚部/転子部骨折診療ガイドライン 改訂第2版.南江堂
患者向け説明資料

概要・推奨   

  1. できる限り早期の手術を推奨する(推奨度2J
  1. MRIは有用で診断精度はきわめて高い(推奨度1J
  1. 高齢者の転位型(Garden stage III,stage IV)は人工物置換術を推奨する(推奨度1J
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要と
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要とな
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
加来信広 : 特に申告事項無し[2021年]
監修:酒井昭典 : 講演料(旭化成ファーマ(株),第一三共(株),中外製薬(株)),奨学(奨励)寄付など(旭化成ファーマ(株),第一三共(株),中外製薬(株))[2021年]

改訂のポイント:
  1. 定期レビューを行い、大腿骨頚部/転子部骨折診療ガイドラインに基づき、応急処置とフォローアップ方針について加筆を行った。

病態・疫学・診察

疾患情報(疫学・病態)  
  1. 大腿骨頚部骨折とは、大腿骨の頚部に発生する骨折で、関節包内骨折(滑膜性関節包内)である。
  1. 近年、男女とも増加している骨折で、70歳を過ぎると、急激に増加している。
  1. 危険因子となる既往症・疾病・家族歴として脆弱性骨折の既往、親の大腿骨頚部/転子部骨折既往、胃切除の既往、甲状腺機能亢進症、性腺機能低下症、糖尿病、腎機能低下、膝痛は危険因子、視力障害などがある。
  1. 喫煙、向精神薬、加齢、低体重、多量のカフェイン摂取および未産も危険因子である。
  1. 転倒が最も多い。
  1. 転倒は高齢になるほど頻度が高く、医療介入施設入所中の高齢者は在宅高齢者より転倒する割合が多い。
問診・診察のポイント  
問診:
  1. 転倒の有無を確認する。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: M J Parker, H H Handoll
雑誌名: Cochrane Database Syst Rev. 2001;(3):CD000168. doi: 10.1002/14651858.CD000168.
Abstract/Text BACKGROUND: Pre-operative traction following an acute hip fracture remains standard practice in some hospitals.
OBJECTIVES: To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered.
SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group's specialised register (April 2001), the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2001), MEDLINE (1966 to February 2001), EMBASE (1988 to 2001 Week 11), CINAHL (1982 to February 2001), the National Research Register Issues 3, 2000 and 1, 2001, and reference lists of articles. Date of most recent search: April 2001.
SELECTION CRITERIA: All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery.
DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically.
MAIN RESULTS: Seven randomised trials, mainly of moderate quality, involving a total of 1038 predominantly elderly patients, were identified and included in the review. This review update includes a newly identified trial. The inclusion of this trial, which focussed on analgesia outcomes, resulted in no important change in the results or conclusions. Six trials compared traction with no traction. Although no data pooling was possible, overall these provided no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other which compared skeletal traction with skin traction found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and most costly.
REVIEWER'S CONCLUSIONS: From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use. Further, high quality trials would be required to confirm or refute the absence of benefits of traction.

PMID 11686954  Cochrane Database Syst Rev. 2001;(3):CD000168. doi: 10.・・・
著者: Arun Kannan, Ramprasad Kancherla, Stephen McMahon, Gabrielle Hawdon, Aditya Soral, Rajesh Malhotra
雑誌名: Int Orthop. 2012 Jan;36(1):1-8. doi: 10.1007/s00264-011-1354-z. Epub 2011 Sep 20.
Abstract/Text PURPOSE: Femoral-neck fracture in the elderly population is a problem that demands the attention of the orthopaedic community as life expectancy continues to increase. There are several different treatment options in use, and this variety in and of itself indicates the absence of an ideal single treatment option. Recent debate has focussed on the probable superiority of total hip arthroplasty (THA) over hemiarthroplasty for femoral-neck fracture. Clinical trials and systematic reviews of such trials have not provided a convincing answer to this question.
METHODS: We analysed data from national registries evaluating prosthetic replacements for femoral-neck fracture in the elderly. We compared revision and reoperation rates of hemiarthroplasty and THA, analysed the prognostic variables that influenced implant survival and the major causes of failure.
RESULTS: Data from the Australian and Italian registries indicate that THA has an increased revision rate compared with bipolar hemiarthroplasty in femoral-neck fracture in the elderly. The registries identify that age over 75 years and the use of the anterior surgical approach are associated with better survivorship in patients who have a hemiarthroplasty. Cemented fixation of the femoral stem in hemiarthroplasty and THA is supported by registry data. Acetabular erosion accounted for a very low percentage of hemiarthroplasty revisions and reoperations.
CONCLUSION: Our review of data from national registries supports the continued use of bipolar hemiarthroplasty in femoral-neck fracture in the elderly and identifies age, method of fixation and surgical approach as important prognostic variables in determining implant survival.

PMID 21931966  Int Orthop. 2012 Jan;36(1):1-8. doi: 10.1007/s00264-011・・・
著者: Bjarke Viberg, Søren Overgaard, Jens Lauritsen, Ole Ovesen
雑誌名: Acta Orthop. 2013 Jun;84(3):254-9. doi: 10.3109/17453674.2013.792033. Epub 2013 Apr 18.
Abstract/Text BACKGROUND AND PURPOSE: Elderly patients with displaced femoral neck fractures are commonly treated with a hemiarthroplasty (HA), but little is known about the long-term failure of this treatment. We compared reoperation rates for patients aged at least 75 years with displaced femoral neck fractures treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up.
METHODS: 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1 (1991-1993) with 180 patients had undergone IF; cohort 2 (1991-1995) with 203 patients had received an uncemented bipolar Ultima HA stem (Austin-Moore); cohort 3 (1991-1995) with 209 patients had received a cemented Charnley-Hastings HA; and cohort 4 (1991-1998) with 158 patients had received an uncemented hydroxyapatite-coated Furlong HA. Data were retrieved from patient files, from the region-based patient administrative system, and from the National Registry of Patients at the end of 2010. We performed survival analysis with adjustment for comorbidity, age, and sex.
RESULTS: Cemented HA had a reoperation rate (RR) of 5% and was used as reference in the Cox regression analysis, which showed significantly higher hazard ratios (HRs) for IF (HR = 3.8, 95% CI: 1.9-7.5; RR = 18%), uncemented HA (HR = 2.2, CI: 1.1-4.5; RR = 11%) and uncemented hydroxyapatite-coated HA (HR = 3.6, CI: 1.8-7.4; RR = 16%).
INTERPRETATION: Cemented HA has a superior long-term hip survival rate compared to IF and uncemented HA (with and without hydroxyapatite coating) in patients aged 75 years or more with displaced femoral neck fractures.

PMID 23594248  Acta Orthop. 2013 Jun;84(3):254-9. doi: 10.3109/1745367・・・
著者: Chen-Chiang Lin, Shier-Chieg Huang, Yang-Kun Ou, Yung-Ching Liu, Ching-Mei Tsai, Hsin-Hui Chan, Chen-Ti Wang
雑誌名: Asian J Surg. 2012 Apr;35(2):62-6. doi: 10.1016/j.asjsur.2012.04.002. Epub 2012 Jun 2.
Abstract/Text OBJECTIVES: Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survival of patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis.
METHODS: An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years. Demographic data were collected. Survival rate at 5 years and factors related to mortality were analyzed.
RESULTS: Sixty-two patients received Austin-Moore hemiarthroplasty, and 58 received bipolar hemiarthroplasty. No significant differences in gender, comorbid conditions, ASA scores, duration of hospitalization, intraoperative blood loss, duration from injury to operation, or postoperative morbidity between the two groups were found. However, patients who received the Austin-Moore hemiarthroplasty were older and had shorter operation time than those who received bipolar hemiarthroplasty. Kaplan-Meier estimates of 5 years survival were 40.0% for patients who received Austin-Moore hemiarthroplasty, and 62.9% for patients who received bipolar hemiarthroplasty. Cox proportional hazard regression analysis of risks factors of death revealed that patients who underwent Austin-Moore hemiarthroplasty were 2.0-fold more likely to die when compared to those who received bipolar hemiarthroplasty.
CONCLUSIONS: Elderly patients who receive bipolar hemiarthroplasty may have a more favorable survival outcome when compared to those who receive unipolar hemiarthroplasty.

Copyright © 2012. Published by Elsevier B.V.
PMID 22720860  Asian J Surg. 2012 Apr;35(2):62-6. doi: 10.1016/j.asjsu・・・
著者: Kari Kanto, Raine Sihvonen, Antti Eskelinen, Minna Laitinen
雑誌名: Arch Orthop Trauma Surg. 2014 Sep;134(9):1251-9. doi: 10.1007/s00402-014-2053-1. Epub 2014 Jul 24.
Abstract/Text INTRODUCTION: The choice between unipolar and bipolar hemiarthroplasty for treatment of displaced intracapsular femoral neck fractures in elderly patients still remains controversial. Our objective was to compare series of elderly individuals with a displaced femoral neck fracture treated with either a cemented, modular unipolar or bipolar prosthesis with the same femoral component.
MATERIALS AND METHODS: A prospective, randomized controlled trial of 175 displaced intracapsular femoral neck fractures in patients over 65 years was randomly allocated to unipolar (88) and to bipolar (87) hemiarthroplasty group. The primary end point was implant survival. Secondary end points included difference in ambulatory ability and mortality. Follow-up evaluations were performed at 2 months, at 1, 3 and 5 years. Implant and patient survival were followed until 2/2012. Survival analyses were performed using Kaplan-Meier curves with log-rank test. Data were analyzed using Chi-square test and Student's t test.
RESULTS: Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. This did not translate into difference in revision rates at 8 years. Prosthetic survival ship was 0.98 (95% Cl 0.94-1.00) in the unipolar group and 0.97 (95% Cl 0.93-1.00) in the bipolar group. There were no statistically significant differences in ambulatory ability, possibility to return home mortality or early radiological acetabular erosion. There were significantly more one-time dislocations in the unipolar group, but there was no difference in incidence of revisions due to recurrent dislocations. The overall mortality rate was 6% at 30 days, 9% at 90 days, 16% at 12 months, and 53% at 5 years. There was no difference in mortality between the groups.
CONCLUSIONS: Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. However, both provide elderly patients with equal ambulatory ability and low revision rate at medium-term follow-up.

PMID 25055754  Arch Orthop Trauma Surg. 2014 Sep;134(9):1251-9. doi: 1・・・
著者: Klaus Hauer, Norbert Specht, Matthias Schuler, Peter Bärtsch, Peter Oster
雑誌名: Age Ageing. 2002 Jan;31(1):49-57. doi: 10.1093/ageing/31.1.49.
Abstract/Text BACKGROUND: Intensive exercise training can lead to improvement in strength and functional performance in older people living at home and nursing home residents. There is little information whether intensive physical exercise may be applicable and effective in elderly patients suffering from the acute sequelae of injurious falls or hip surgery.
OBJECTIVE: To assess the feasibility, safety and efficacy of intensive, progressive physical training in rehabilitation after hip surgery.
DESIGN: Prospective, randomised, placebo-controlled intervention study of a 3-months training intervention and a 3-months' follow-up.
SETTING: Physical training 6-8 weeks after hip surgery.
SUBJECTS: Twenty-eight (15 intervention, 13 control) elderly patients with a history of injurious falls admitted to acute care or inpatient rehabilitation because of acute fall-related hip fracture or elective hip replacement.
METHODS: Progressive resistance and functional training to improve strength and functional performance.
RESULTS: No training-related medical problems occurred in the study group. Twenty-four patients (86%) completed all assessments during the intervention and follow-up period. Adherence was excellent in both groups (intervention: 93, 0+/-13, 5% versus control: 96, 7+/-6, 2%). Training significantly increased strength, functional motor performance and balance and reduced fall-related behavioural and emotional problems. Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training. Patients in the control group showed no change in strength, functional performance and emotional state during intervention and follow-up.
CONCLUSIONS: Progressive resistance training and progressive functional training are safe and effective methods to increase strength and functional performance during rehabilitation in patients after hip surgery and a history of injurious falls. Because part of the training improvements were lost after stopping the training, a continuing training regime should be established.

PMID 11850308  Age Ageing. 2002 Jan;31(1):49-57. doi: 10.1093/ageing/3・・・
著者: Ellen F Binder, Marybeth Brown, David R Sinacore, Karen Steger-May, Kevin E Yarasheski, Kenneth B Schechtman
雑誌名: JAMA. 2004 Aug 18;292(7):837-46. doi: 10.1001/jama.292.7.837.
Abstract/Text CONTEXT: Hip fractures are common in the elderly, and despite standard rehabilitation, many patients fail to regain their prefracture ambulatory or functional status.
OBJECTIVE: To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture.
DESIGN, SETTING, AND PATIENTS: Randomized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed standard physical therapy.
INTERVENTION: Participants were randomly assigned to 6 months of either supervised physical therapy and exercise training (n = 46) or home exercise (control condition; n = 44).
MAIN OUTCOME MEASURES: Primary outcome measures were total scores on a modified Physical Performance Test (PPT), the Functional Status Questionnaire physical function subscale (FSQ), and activities of daily living scales. Secondary outcome measures were standardized measures of skeletal muscle strength, gait, balance, quality of life, and body composition. Participants were evaluated at baseline, 3 months, and 6 months.
RESULTS: Changes over time in the PPT and FSQ scores favored the physical therapy group (P =.003 and P =.01, respectively). Mean change (SD) in PPT score for physical therapy was +6.5 (5.5) points (95% confidence interval [CI], 4.6-8.3), and for the control condition was +2.5 (3.7) points (95% CI, 1.4-3.6 points). Mean change (SD) in FSQ score for physical therapy was +5.2 (5.4) points (95% CI, 3.5-6.9) and for the control condition was +2.9 (3.8) points (95% CI, 1.7-4.0). Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength, walking speed, balance, and perceived health but not bone mineral density or fat-free mass.
CONCLUSION: In community-dwelling frail elderly patients with hip fracture, 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise.

PMID 15315998  JAMA. 2004 Aug 18;292(7):837-46. doi: 10.1001/jama.292.・・・
著者: Magnus Eneroth, Ulla-Britt Olsson, Karl-Göran Thorngren
雑誌名: Clin Orthop Relat Res. 2006 Oct;451:212-7. doi: 10.1097/01.blo.0000224054.86625.06.
Abstract/Text Protein energy malnutrition is an important determinant of clinical outcome in older patients after hip fracture, but the effectiveness of nutritional support programs in routine clinical practice is controversial. We performed a prospective, randomized, controlled clinical trial to determine if nutritional supplementation decreased fracture-related complications in a selection of otherwise healthy patients with hip fractures. Patients were randomized to intervention or control groups. The control group (n = 40) was given ordinary hospital food and beverage. The intervention group (n = 40) also was administered a 1000 kcal daily intravenous supplement for 3 days, followed by a 400 kcal oral nutritional supplement for 7 days. We recorded daily fluid and energy intake during the first 10 days of hospitalization and fracture-related complications up to 4 months. The total fluid and energy intake in the intervention group neared optimal levels. The control group received 54% and 64% of optimal energy and fluid intake, respectively. The risk of fracture- related complications was greater in the control group (70%) than in the intervention group (15%). Four patients in the control group died within 120 days postoperatively. The comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively.

PMID 16770284  Clin Orthop Relat Res. 2006 Oct;451:212-7. doi: 10.1097・・・
著者: D S Damany, Martyn J Parker, Adrian Chojnowski
雑誌名: Injury. 2005 Jan;36(1):131-41. doi: 10.1016/j.injury.2004.05.023.
Abstract/Text UNLABELLED: Intracapsular hip fractures in young adults have a significant risk of complications. Consequently, some authors advocate urgent and/or open fracture reduction. Our aim was to analyse outcomes following such fractures with reference to influence of fracture displacement, timing of surgery and method of reduction (open/closed) on the incidence of non-union (NU) and avascular necrosis (AVN).
METHODS: Specific search terms were used to retrieve relevant published studies from 1966 to May 2003.
RESULTS: Eighteen studies involving 564 fractures were analysed. The overall incidence of NU was 50/564 (8.9%) and AVN was 130/564 (23.0%). There was a higher incidence of NU and AVN following displaced than undisplaced fractures. NU occurred more frequently after open reduction than closed reduction (10/89 [11.2%] versus 13/275 [4.7%]). There was an increased incidence of AVN after closed than open reduction but this was no longer statistically significant when one study with a markedly higher reported incidence of AVN was excluded. The difference in the incidence of NU and AVN following early (<12h) or late (>12 h) surgery was not significant for either NU or AVN.
CONCLUSION: Early or open reduction of these fractures may not reduce the risk of NU or AVN. There is a suggestion of a higher incidence of NU following open reduction than closed reduction. Randomised studies with 2 year follow-up are required to report on a larger number of patients before definite conclusions on treatment can be made.

PMID 15589931  Injury. 2005 Jan;36(1):131-41. doi: 10.1016/j.injury.20・・・
著者: Kevin S Conn, Martyn J Parker
雑誌名: Clin Orthop Relat Res. 2004 Apr;(421):249-54.
Abstract/Text Three hundred seventy-five patients with an undisplaced intracapsular proximal femoral fracture were treated with internal fixation. Nonunion occurred in 24 patients (6.4%) and avascular necrosis occurred in 15 patients (4.0%). Reoperation with an arthroplasty was required in 29 patients (7.7%). The age, walking ability of the patient, and degree of impaction seen on the anteroposterior radiograph or angulation seen on the lateral radiographs were of statistical significance in predicting fracture healing complications. The results for this series of patients were compared with the results in published reports identified by a comprehensive literature search. Summation of the results indicated that the overall risk of redisplacement or nonunion of the fracture was 4.3% (95% confidence interval, 3.4%-5.3%) with internal fixation of an undisplaced intracapsular fracture. For conservative treatment, the failure rate was 19.6% (95% confidence interval, 17.2%-22.1%). The incidence of avascular necrosis with internal fixation at 1 year was 2.2% (95% confidence interval, 1.6%-2.9%) compared with 2.8% (95% confidence interval, 1.9%-4.0%) with nonoperative treatment. Internal fixation is recommended for the treatment of undisplaced intracapsular hip fractures.

PMID 15123955  Clin Orthop Relat Res. 2004 Apr;(421):249-54.
著者: M Clare Robertson, A John Campbell, Melinda M Gardner, Nancy Devlin
雑誌名: J Am Geriatr Soc. 2002 May;50(5):905-11. doi: 10.1046/j.1532-5415.2002.50218.x.
Abstract/Text OBJECTIVES: Our falls prevention research group has conducted four controlled trials of a home exercise program to prevent falls in older people. The objectives of this meta-analysis of these trials were to estimate the overall effect of the exercise program on the numbers of falls and fall-related injuries and to identify subgroups that would benefit most from the program.
DESIGN: We pooled individual-level data from the four trials to investigate the effect of the program in those aged 80 and older, in those with a previous fall, and in men and women.
SETTING: Nine cities and towns in New Zealand.
PARTICIPANTS: One thousand sixteen community dwelling women and men aged 65 to 97.
INTERVENTION: A program of muscle strengthening and balance retraining exercises designed specifically to prevent falls and individually prescribed and delivered at home by trained health professionals.
MEASUREMENTS: Main outcomes were number of falls and number of injuries resulting from falls during the trials.
RESULTS: The overall effect of the program was to reduce the number of falls and the number of fall-related injuries by 35% (incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI) = 0.57-0.75; and, respectively IRR = 0.65, 95% CI = 0.53-0.81.) In injury prevention, participants aged 80 and older benefited significantly more from the program than those aged 65 to 79. The program was equally effective in reducing fall rates in those with and without a previous fall, but participants reporting a fall in the previous year had a higher fall rate (IRR = 2.34, 95% CI = 1.64-3.34). The program was equally effective in men and women.
CONCLUSION: This exercise program was most effective in reducing fall-related injuries in those aged 80 and older and resulted in a higher absolute reduction in injurious falls when offered to those with a history of a previous fall.

PMID 12028179  J Am Geriatr Soc. 2002 May;50(5):905-11. doi: 10.1046/j・・・
著者: Socrates E Papapoulos, Sara A Quandt, Uri A Liberman, Marc C Hochberg, Desmond E Thompson
雑誌名: Osteoporos Int. 2005 May;16(5):468-74. doi: 10.1007/s00198-004-1725-z. Epub 2004 Sep 21.
Abstract/Text Treatment with alendronate, a potent and specific inhibitor of bone resorption, is known to significantly reduce fracture risk among women with postmenopausal osteoporosis. The purpose of this meta-analysis was to assess the consistency of the effect of alendronate in reducing the risk of hip fracture among different studies and populations. Data from completed, randomized, treatment studies were pooled in a meta-analysis. The duration of the studies ranged from 1-4.5 years. The dose of alendronate ranged from 5-20 mg/day, with over 95% of patients receiving either 5 or 10 mg/day during the trials. In patients with a T-score of less than or equal to -2.0, or with a vertebral fracture, the effect on hip fracture risk consistently favored patients receiving alendronate therapy, with an overall reduction in risk of hip fracture of 45% [95% confidence interval (CI) 16% to 64%, P=0.007]. For patients who met the criteria of osteoporosis, as defined by the World Health Organization (WHO), the overall risk reduction was 55% (95% CI 29% to 72%, P=0.0008). In both analyses we performed a sensitivity analysis by removing one study at a time. The strength of the evidence was not dependent on any one study. We conclude that therapy with alendronate is associated with significant and clinically important reductions in the incidence of hip fracture in women with postmenopausal osteoporosis. The overall reduction is consistent among different patient populations.

PMID 15448985  Osteoporos Int. 2005 May;16(5):468-74. doi: 10.1007/s00・・・

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