骨质疏松性骨折患者跌倒风险感知的时间演变及影响因素

doi:10.12183/j.scjpm.2026.0422

摘要/Abstract

摘要： 目的探讨骨质疏松性骨折患者跌倒风险感知的时间演变及影响因素。方法采用前瞻性研究设计,选取2023年1月—2024年10月收治的118例骨质疏松性骨折患者为研究对象,分别在出院时（T0）、出院后1个月（T1）、出院后3个月（T2）、出院后6个月（T3）、出院后12个月（T4）通过跌倒风险感知量表对患者进行随访调查,采用潜类别增长模型（LCGM）识别跌倒风险感知评分的变化轨迹,采用logistic回归分析跌倒风险感知评分发展轨迹的影响因素。结果 118例骨质疏松性骨折患者出院时（T0）、出院后1个月（T1）、出院后3个月（T2）、出院后6个月（T3）、出院后12个月（T4）的跌倒风险感知得分依次为（47.66±8.41）、（50.65±8.92）、（51.50±10.68）、（49.16±12.42）、（47.33±12.21）分;LCGM分析显示,118例骨质疏松性骨折患者跌倒风险感知评分分为3种变化轨迹,即类别1为持续低风险感知组（34例,占28.81%）、中度波动组（56例,占47.46%）和持续高风险感知组（28例,占23.73%）。有序多分类logistic回归分析结果显示,年龄<60岁（OR=3.559、4.311）、文化程度初中以上（OR=3.326、4.896）、有跌倒史（OR=2.985、4.180）、无抑郁（OR=2.888、2.804）、骨质疏松相关知识储备良好（OR=3.286、4.255）者更易进入中度波动组或持续高风险感知组（均P<0.05）。结论骨质疏松性骨折患者的跌倒风险感知可随时间演变而呈不同变化轨迹。年龄、文化程度、跌倒史、抑郁及骨质疏松相关知识储备均是跌倒风险感知的影响因素。医护人员可关注不同轨迹人群的特征制定个体化干预方案,以提高跌倒风险感知水平。

关键词: 骨质疏松性骨折, 跌倒风险感知, 潜类别增长模型, 影响因素, 抑郁, 跌倒史

Abstract: Objective To investigate the temporal evolution of fall risk perception and its determinants in patients with osteoporotic fractures. Methods A prospective study design was employed, enrolling 118 patients with osteoporotic fractures admitted between January 2023 and October 2024. Patients were surveyed using the Fall Risk Perception Scale at five time points: at discharge (T0), and at 1 month (T1), 3 months (T2), 6 months (T3), and 12 months (T4) post-discharge. A latent class growth model (LCGM) was utilized to identify distinct trajectories of fall risk perception scores over time. Subsequently, logistic regression analysis was performed to ascertain the factors influencing these developmental trajectories. Results The mean fall risk perception scores for the 118 patients were (47.66±8.41) at T0, (50.65±8.92 )at T1, (51.50±10.68) at T2, (49.16±12.42) at T3, and (47.33±12.21) at T4. The LCGM analysis identified three distinct trajectories for fall risk perception scores: a "sustained low-risk perception" group (n=34, 28.81%), a "moderate fluctuation" group (n=56, 47.46%), and a "sustained high-risk perception" group (n=28, 23.73%). Ordinal multinomial logistic regression analysis revealed that patients who were younger than 60 years (OR=3.559, 4.311), had an educational attainment of junior high school or higher (OR=3.326, 4.896), reported a history of falls (OR=2.985, 4.180), had no depression (OR=2.888, 2.804), or possessed a good knowledge of osteoporosis (OR=3.286, 4.255) were significantly more likely to belong to the moderate fluctuation or sustained high-risk perception groups (all P<0.05). Conclusion The perception of fall risk among patients with osteoporotic fractures follows distinct temporal trajectories. Age, educational attainment, history of falls, depression, and osteoporosis-related knowledge are significant determinants of these trajectories. Healthcare professionals should consider the specific characteristics of these different trajectory groups to develop tailored, individualized intervention strategies aimed at enhancing patients' perception of fall risk.

Key words: Osteoporotic fractures, Fall risk perception, Latent class growth modeling, Influencing factors, Depression, History of falls

中图分类号:

R161.7

张宏玲, 郭晓霞, 潘李. 骨质疏松性骨折患者跌倒风险感知的时间演变及影响因素[J]. 华南预防医学, 2026, 52(4): 422-427.

Zhang Hongling, Guo Xiaoxia, Pan Li. Temporal evolution and influencing factors of fall risk perception in patients with osteoporotic fractures[J]. South China Journal of Preventive Medicine, 2026, 52(4): 422-427.

参考文献

[1] Ensrud KE, Crandall CJ. Osteoporosis[J]. Ann Intern Med, 2024, 177(1): ITC1-ITC16.
[2] Liu ZJ, Zhang C, Ma C, et al.Criteria for osteoporosis diagnosis: A systematic review and meta-analysis of osteoporosis diagnostic studies with DXA and QCT[J]. EClinicalMedicine, 2025, 55: 102476.
[3] Subarajan P, Arceo-Mendoza RM, Camacho PM.Postmenopausal osteoporosis: A review of latest guidelines[J]. Endocrinol Metab Clin North Am, 2024, 53(4): 497-512.
[4] 黄震, 王志伟, 陈杰, 等. 骨质疏松症患者脆性骨折的影响因素及预测模型构建[J]. 华南预防医学, 2025, 51(12): 1315-1320.
[5] 中华医学会骨质疏松和骨矿盐疾病分会. 骨质疏松性椎体压缩性骨折诊疗与管理专家共识[J]. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(5): 425-437.
[6] 鲍冠君, 朱琳, 罗烨. 糖尿病病人跌倒风险感知与客观跌倒风险的一致性及其影响因素[J]. 护理研究, 2025, 39(21): 3590-3595.
[7] 张仲婷, 陈龙, 曾凯, 等. 老年人跌倒风险感知研究现状及其对老年人主动跌倒预防的启示[J]. 中国全科医学, 2024, 27(19): 2395-2400.
[8] 刘玉洁, 孙世威, 孟霞. 中老年骨质疏松性骨折危险因素及预测模型[J]. 中国骨质疏松杂志, 2026, 32(2): 171-175.
[9] Lu L, Tian L.Postmenopausal osteoporosis coexisting with sarcopenia: The role and mechanisms of estrogen[J]. J Endocrinol, 2023, 259(1): 230116.
[10] Ramchand SK, Leder BZ.Sequential therapy for the long-term treatment of postmenopausal osteoporosis[J]. J Clin Endocrinol Metab, 2024, 109(2): 303-311.
[11] Guo C, Ensrud KE, Cauley JA, et al. Fall trajectories in older men: Trajectories of change by age and predictors for future fall risk[J]. J Gerontol A Biol Sci Med Sci, 2024, 79(11): glae217.
[12] 万维, 周浩, 季学丽, 等. 重型脑外伤患者替代决策者决策困境的潜在剖面分析及影响因素研究[J]. 中华神经外科疾病研究杂志, 2026, 20(3): 92-98.
[13] Yang X, Ma J, Li H.Trajectories of depressive symptoms and risk of chronic liver disease: Evidence from CHARLS[J]. BMC Gastroenterol, 2025, 25(1): 338.
[14] Chen X, Lin S, Zheng Y, et al.Long-term trajectories of depressive symptoms and machine learning techniques for fall prediction in older adults: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)[J]. Arch Gerontol Geriatr, 2023, 111: 105012.
[15] 马远征, 王以朋, 刘强, 等. 中国老年骨质疏松诊疗指南(2018)[J]. 中国老年学杂志, 2019, 39(11): 2557-2575.
[16] 梁德清. 高校学生应激水平及其与体育锻炼的关系[J]. 中国心理卫生杂志, 1994(1): 5-6.
[17] 朱宇航, 郭继志, 罗盛, 等. 简易应对方式问卷在老年人群体中的修订及信效度检验[J]. 中国卫生统计, 2016, 33(4): 660-664.
[18] 鲍冠君, 罗烨, 刘苑菲, 等. 社区老年人跌倒风险感知量表的编制及信效度检验[J]. 护理学杂志, 2022, 37(24): 9-13.
[19] 许正芬, 杨晓娣, 李欢. 嘉兴市2022年基层妇科医生对骨质疏松症相关知识的认知调查[J]. 中国乡村医药, 2024, 31(12): 3-5.
[20] Morita K, Nogawa K, Watanabe Y, et al.Possible association between physical and cognitive function and stumbling and falling in elderly workers[J]. Int J Environ Res Public Health, 2022, 19(21): 13826.
[21] Souza LF, Batista REA, Camapanharo CRV, et al.Factors associated with risk, perception and knowledge of falls in elderly people[J]. Rev Gaucha Enferm, 2022, 43(1): 20200335.
[22] 杨嫦, 周敏捷, 凌乐洁, 等. 老年髋部骨折患者术后康复期跌倒风险与风险感知的差异性[J]. 中华全科医学, 2025, 23(1): 148-152.
[23] Li L, Wu L, Mao Y, et al.Fear of falling and depression in older adults: Aging attitudes and social networks as chain mediators[J]. BMC Psychol, 2025, 13(1): 382.
[24] Lee Y, Kim DH.A preliminary study on the effects of an osteoporosis prevention program based on an information-motivation-behavioral skill model in older adult women: A cluster randomized controlled trial[J]. Geriatr Nurs, 2022, 45: 55-63.