中国骨质疏松杂志

老年低能量胸腰椎压缩性骨折临床特征和维生素D营养状态分析

Analysis of clinical characteristics and vitamin D nutritional status in elderly patients with low energy thoracolumbar compression fractures

DOI：10.3969/j.issn.1006-7108.2023.12.009

中文关键词: 老年压缩性骨折骨质疏松维生素D 骨密度

英文关键词:elderly compression fracture osteoporosis vitamin D bone mineral density

基金项目:

作者	单位
陈水绵1 郭庆昕1* 庄跃玲1 饶华春1 郑国良2 柯晓斌3 吴志强3 林小明3	1.泉州市正骨医院检验科，福建泉州 362000 2.泉州市正骨医院康复科，福建泉州 362000 3.泉州市正骨医院脊柱科，福建泉州 362000

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中文摘要:

目的探讨老年低能量胸腰椎压缩性骨折患者的骨密度与维生素D营养状态的关系，为预防骨质疏松性骨折以及骨折后的抗骨质疏松治疗提供参考。方法收集2018年1月至2022年12月因低能量损伤在我院就诊，年龄≥60岁胸腰椎压缩性骨折患者1128例，其中女性928例，男性200例；单椎体骨折896例，多椎体骨折232例。分析不同年龄段、骨折类型、骨密度、性别以及不同时间的25(OH)D水平的差异。结果病例集平均年龄（72.57±7.75）岁，25(OH)D平均水平为（25.08±9.02）ng/L，女性患者是男性的4.64倍。骨折部位最常见为T12、L1，多椎体骨折患者的平均年龄高于单椎体骨折（t=2.057，P=0.04）。随着年龄的增长，25(OH)D水平出现显著下降（F=5.258，P=0.005），而骨质疏松率明显升高（?2=12.322，P=0.002）。老年女性患者的25(OH)D水平明显低于老年男性[(29.26±10.47) μg/L vs. (24.18±8.42) μg/L；t=7.404，P＜0.01]。近3/4老年女性患者存在VD不足，其中VD缺乏占32.0%（297/928），VD缺乏风险是男性的1.47倍；同时1/2以上（58%）男性患者存在VD不足。夏季VD水平显著高于其他季节，其中5、8月份VD水平显著高于其他月份。25(OH)D与T值均呈正相关，且股骨颈相关性大于腰椎（r=0.114，P＜0.01 vs. r=0.073，P=0.015）；另外，股骨颈不同亚组的25(OH)D水平存在显著性差异（P＜0.01），骨质疏松组女性的25(OH)D水平显著低于正常组。结论老年低能量胸腰椎压缩性骨折以女性为主；老年女性患者VD水平显著低于男性；不同月份、季节VD水平有差异；VD水平与BMD存在相关性。

英文摘要:

Objective To explore the relationship between bone mineral density and vitamin D nutritional status in elderly patients with low-energy thoracic and lumbar compression fractures, and to provide a reference for the prevention of osteoporotic fractures and anti-osteoporotic treatment after fractures. Methods From January 2018 to December 2022, 1128 patients with thoracic and lumbar compression fractures aged over 60 years old were collected, including 928 women and 200 men. There were 896 cases of single vertebral fracture and 232 cases of multivertebral fractures. Differences in 25(OH)D levels over time were analyzed by age group, fracture type, bone mineral density, sex, and timing. Results The mean age of the case set was 72.57±7.75 years, the level of 25(OH)D was 25.08±9.02 ng/L, and the female patients were 4.64 times more than the male patients. The most common fracture sites were T12 and L1. The average age of patients with multiple vertebral fractures was higher than that of single vertebral fractures (t=2.057, P=0.04). Along with aging, the level of 25(OH)D decreased significantly (F=5.258, P=0.005), while the osteoporosis rate increased significantly (χ2=12.322, P=0.002). The level of 25(OH)D in elderly women was significantly lower than that in elderly men (29.26±10.47 vs 24.18±8.42 μg/L; t=7.404，P<0.01). Nearly 3/4 elderly women had VD deficiency, of which VD deficiency accounted for 32.0% (297/928), and the risk of VD deficiency was 1.47 times more than that of men. At the same time, more than 1/2 (58%) of male patients had VD insufficiency. VD levels in summer were significantly higher than in other seasons. VD levels in May and August were significantly higher than in other months. 25(OH)D and T values were positively correlated, and the femoral neck correlation was greater than that of the lumbar spine (r=0.114, P<0.01 vs r=0.073, P=0.015). In addition, there was a significant difference in 25(OH)D levels (P<0.01) between different subgroups of the femoral neck. The 25(OH)D levels of women in the osteoporosis group were significantly lower than those in the normal group. Conclusion Low-energy thoracic and lumbar compression fractures are mainly in elderly females. Older women have significantly lower VD levels than men. VD levels vary from month to month and season. There is a correlation between VD levels and bone mineral density.

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