여성 노인에서 출산력과 고관절 골절 발생간의 관련성 : 코호트 연구

Reproductive History and Hip Fracture in the Elderly Women in Korea : A Cohort Study

  • 이승미 (서울대학교 의과대학 예방의학교실) ;
  • 김윤이 (서울대학교 의과대학 예방의학교실) ;
  • 윤경은 (서울대학교 의과대학 예방의학교실) ;
  • 박병주 (서울대학교 의과대학 예방의학교실)
  • Lee, Seung-Mi (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Kim, Yoon-I (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Youn, Koung-Eun (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Park, Byung-Joo (Department of Preventive Medicine, Seoul National University College of Medicine)
  • 발행 : 2002.12.01

초록

Objectives : The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. Methods : The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. Results : Following up 5,215 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25-1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34-1.08) compared with those who had giving birth at 22 years or older. Conclusions : According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.

키워드

참고문헌

  1. 통계청. 1999년 생명표 작성 결과 2001
  2. 통계청. 1999년 장래인구 추계 결과. 2001
  3. Harrison's Principles of Internal Medicine. $14^{th}$ ed.1998
  4. Peel N. Osteoporosis. British Med J 1995; 310: 989-992 https://doi.org/10.1136/bmj.310.6985.989
  5. Haetjens P, Autoer P, Barette M, Boonen S. The economic cost of hip fractures. J Bone Joint Surg Am 2001; 83-A: 493-500 https://doi.org/10.2106/00004623-200104000-00003
  6. 의료보험관리공단. 의료보험통계연보. 1997
  7. Park BJ, Jung KO, Bae JM, Koo HW, Kim OS. Cohort study on the association between smoking and proximal hip fracture in the elderly people in Korea. Korean J Epidemiol 1998; 20: 246-256 (Korean)
  8. 통계청. 2000년 출생 사망 통계결과. 2001
  9. 통계청. 1999년 인구동태 통계결과. 2000
  10. Sowers M. Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 1996; 11: 1052-1060 https://doi.org/10.1002/jbmr.5650110803
  11. Park BJ, Cho YK, Kim SA. Construction of the Korea Elderly pharmacoepidemiologic Cohort; drug utilization review of cephalosporins in geriatric inpatients. Phannacoepidemiol Drug Safe 2001; 10: 487-492 https://doi.org/10.1002/pds.665
  12. Park BJ, Bae JM, Koo HW, Kim OS, Kwon JS, Jin K. Cohort study on the association between psychotropics and proximal femur fracture in the elderly people in Korea: Interim results. Korean J Clin Pharmacol Ther 1998; 6: 44-54 (Korean)
  13. Park BI, Kim DS, Koo HW, Bae JM. Reliability and validity study of a life style questionnaire for elderly people. Korean J Prev Med 1998; 31: 49-58 (Korean)
  14. SAS Institute Inc. The SAS for windows, Release 6.12. Cary, NC27513, USA, 1989
  15. Bredhal C, Nyholn B, Hindshdm KB, Mortensen JS, Olsen AA : Mortality after hip fractures; Results of operation within twelve hours of admission. Injury 1992; 23: 83-86 https://doi.org/10.1016/0020-1383(92)90037-S
  16. 서울대학교 의과대학 정형외과학교실. 골절학. 1판 일조각. 1988
  17. Ross PD. Osteoporosis: Frequency,consequences, and risk factors. Arch Intern Med 1996; 156: 1399-1411 https://doi.org/10.1001/archinte.156.13.1399
  18. Alderman BW, Weiss NS, Baling JR, Ure CR, Ballard JH. Reproductive history and postmenopause risk of hip fracture. Am J Epidemiol 1986; 124: 262=267 https://doi.org/10.1093/oxfordjournals.aje.a114384
  19. Power ML Heaney RP, kalkwarf HJ, Pitkin RM. The role of calcium in health and disease. Am J Obstet Gynecol 1999; 181: 1560-1569 https://doi.org/10.1016/S0002-9378(99)70404-7
  20. Heckman JD, Sassaral R. Current Concept Review. Musculoskeletal Considerations in Pregnancy. J Bone Joint Surg 1994; 76: 1720-1730 https://doi.org/10.2106/00004623-199411000-00018
  21. Kreiger N, Jelsey JL, Holeford TR, O' connor T. An epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol 1982; 116: 141-148 https://doi.org/10.1093/oxfordjournals.aje.a113388
  22. Nguyen TV, Jones G, Sambrook PN, White CP, Kelly PJ, Eisman JA. Effects of estrogen exposure and reproductive factors on bone mineral density and osteoporotic factures. J Clin Endocrinol Metab 1995; 80: 2709-2714 https://doi.org/10.1210/jc.80.9.2709
  23. Jacobsen BK, Nilssen S, Heuch I, Kvale G. Reproducti ve factors and fatal hip fractures. A Norwegian prospective study of 63,000 women. J Epidemiol Community Health 1998; 52: 645-650 https://doi.org/10.1136/jech.52.10.645
  24. 통계청. 인구주택총조사보고서. 1995