고위험군의 낙상예방 효과를 기대해 볼 수 있을 것이다.
본 연구의 강점으로는 대표성 있는 자료원을 사용하여서 우리나라 일 반 인구를 대표하는 결과를 산출했다는 점을 들 수 있다. 또한 골밀도에 대한 설문조사와 달리 골밀도 측정자료를 이용하여 골다공증 및 골감소 증에 대한 정확한 분류 및 진단이 가능하였으며, 골밀도와 건강행태의 상호작용을 분석하여 낮은 골밀도의 환자들에게 낙상손상의 예방안으로 건강행태 개선의 중요성을 제시하였고, 골감소가 시작되기 전 골밀도 유 지 및 관리의 중요성을 제시한 점이다.
그러나 본 연구는 단면연구로써 골밀도에 따른 낙상손상 위험의 차이 를 확인하였을 뿐, 인과관계나 시간의 선후 관계는 볼 수 없는 한계가 있다. 또한 골밀도를 제외하고 개인의 건강상의 기능적 상태를 고려하지 못하였으며, 손상발생에 영향을 미치는 매개체와 환경적 요인을 고려하 지 못하였다는 제한점이 있다. 따라서 향후 연구에서는 매개체적인 요인 과 환경적인 요인을 고려하여 이러한 특성들이 보정되었을 때에도 골밀 도에 따라 낙상손상 위험에 차이가 있는지를 알아보는 연구가 필요할 것 으로 보인다.
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부 록
1. 손상 및 사고중독 설문문항
2. 신체활동 설문문항
3. 음주 설문문항
4. 흡연 설문문항
ABSTRACT
Risk factors of fall-related injuries and the interaction of bone mineral density
and health behaviours
Lim Dohee Graduate School of Public Health Ajou University
Objective: The aim of this study was to examine the difference in the risk of fall-related injury according to bone mineral density (BMD) and understand the relation between health behaviours and BMD in the Korean general population with analysis of representative sources of data. In addition, features in health behaviours affecting to the risk of fall-related injury by interaction with BMD were investigated.
Methods: Secondary and tertiary data (2008-2009) with BMD checkups
among fourth Korean National Health and Nutrition Examination Survey data was used to examine the relation of fall-related injury and BMD with demographic sociological features, such as sex, age, education level, individual income, residence, and health behavioural features, such as physical activity, daily calcium intake, serum 25-hydroxy vitamin D level, drinking, smoking, obesity. After correcting demographic sociological and health behavioural features related to fall-related injury and BMD, the risk of fall-related injury according to BMD was analyzed by logistic regression model and the relation between BMD and health behaviour was analyzed by chi-square test and multinomial logistic regression analysis. Interaction between BMD and health behaviour was decided by the comparison of expected joint odds ratio and observed joint odds ratio.
Results: In the entire population, the risk of fall-related injury according to BMD was not significantly different. However, the risk of fall-related injury with low BMD (osteopenia and osteoporosis) in the aged over 65 years old and postmenopausal women was higher three times or more than normal BMD. In addition, drinking, obesity and smoking showed interaction with BMD in the risk of fall-related injury and those increased the risk compared to individual effects.
Conclusion: Low BMD in the aged over 65 years old and postmenopausal women was a risk factor of fall-related injury.
Therefore, the aged over 65 years old and postmenopausal women with
low BMD need to be classified into a high-risk group of fall-related injury and managed for prevention. Drinking, smoking, physical activity and weight are health behaviours related to BMD and those should be controlled to prevent fall-related injury. Mentioned health behaviours increased the risk of fall-related injury with low BMD in the aged over 65 years old and postmenopausal women. Therefore, high-risk people should improve health behaviours, such as drinking, smoking, obesity, etc. In this study, we considered only human factors in fall-related injury but injury also can be affected by environmental factors.
Therefore, further studies need to investigate the effect of human factors according to environmental factors on fall-related injury.