中老年人群骨折风险与骨密度、骨代谢指标的相关性研究
Correlation study between the fracture risk assessment FRAX and bone mineral density, bone metabolism biochemical markers in the middle-aged and elderly people in Nanchang
  
DOI:10.3969/j.issn.1006-7108.2024.06.010
中文关键词:  FRAX骨折风险评估  骨质疏松症  骨密度  骨代谢生化指标
英文关键词:fracture risk assessment tool  osteoporosis  bone mineral density  bone metabolism biochemical markers
基金项目:江西省重点研发计划项目(20171BBG70058);南昌市科技支撑计划[洪科验字(2018)237号];江西省卫生健康委科技计划(202311273)
作者单位
曾颖梅1 涂丽莎2 杨枝2 王艳2 涂萍2* 1.江西中医药大学研究生院江西 南昌 330000 2.南昌市人民医院(南昌市第三医院)江西 南昌 330009 
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中文摘要:
      目的 应用FRAX骨折风险评估工具评估南昌市中老年人群发生骨质疏松性骨折的风险,比较男性与女性的骨折风险差异,分析骨折风险与骨密度、骨代谢生化指标的相关性。方法 于2018年6月在南昌市西湖区和青山湖区进行调查,对参与者进行问卷调查(包括年龄、疾病史等)、体格检查(测量身高、体重等)、骨密度检查和实验室检查(包括血糖、骨代谢生化指标等)。采用FRAX计算未来10年发生主要部位骨折概率和髋部骨折概率,并使用SPSS软件对收集的数据进行统计学分析。 结果 共调查了1051名40~90岁南昌市居民,其中男性250名,女性801名,平均年龄为(59±8)岁。骨质疏松症患病率为33.4%,其中男性为21.6%,女性为36.9%。男性的髋部骨折概率、腰椎骨密度、股骨颈骨密度和25-羟基维生素D水平高于女性,主要部位骨折概率、血磷、骨钙素和β胶原特殊序列水平低于女性。Spearman相关及逐步线性回归分析结果显示,在所有参与者中,主要部位骨折概率与腰椎骨密度、股骨颈骨密度及血钙水平呈负相关,与β胶原特殊序列水平呈正相关;髋部骨折概率与腰椎骨密度、股骨颈骨密度、血钙、血磷和骨钙素水平呈负相关,与25-羟基维生素D及β胶原特殊序列水平呈正相关。在男性参与者中,主要部位骨折概率与腰椎骨密度和股骨颈骨密度呈负相关;髋部骨折概率与股骨颈骨密度呈负相关。在女性参与者中,主要部位骨折概率和髋部骨折概率均与腰椎骨密度、股骨颈骨密度和血钙水平呈负相关,与β胶原特殊序列水平呈正相关。以上P值均<0.05。 结论 FRAX值不仅与骨密度有关,还与一些骨代谢生化指标有关;与骨形成标志物骨钙素相比,FRAX值与骨吸收标志物β胶原特殊序列的相关性更为确切。因此,将FRAX与骨密度和骨代谢生化指标结合应用可以更好地预测骨质疏松性骨折的发生风险。
英文摘要:
      Objective To apply the fracture risk assessment tool (FRAX) to assess the risk of osteoporotic fracture in the middle-aged and elderly population in Nanchang City, to compare the difference in fracture risk between men and women, and to analyze the correlation between fracture risk and bone mineral density (BMD), and bone metabolism biochemical markers. Methods The survey was conducted in Xihu District and Qingshanhu District in Nanchang in June 2018. Participants received questionnaires (including age and disease history, etc.), physical examination (measurement of height and weight, etc.), and bone densitometry and laboratory tests (including blood glucose and bone metabolism biochemical markers, etc.). The probability of major osteoporotic fracture (PMOF) and probability of hip fracture (PHF) in the next 10 years were calculated using the FRAX. The collected data were statistically analyzed using SPSS software. Results A total of 1051 Nanchang residents aged 40-90 years were surveyed, including 250 men and 801 women, with an average age of 59±8 years. The prevalence of osteoporosis was 33.4%, with a prevalence of 21.6% in men and 36.9% in women. The PHF, lumbar BMD, femoral neck BMD, and 25-hydroxyvitamin D (25OHD) levels in men were higher than those in women. PMOF, blood phosphorus (P), osteocalcin (OC), and β-carboxy-terminal cross-linked telopeptide of type 1 collagen (β-CTX) levels were lower than those in women. Spearman correlation and stepwise linear regression analysis showed that among all participants, PMOF was negatively correlated with lumbar BMD, femoral neck BMD, and blood Ca levels, and was positively correlated with β-CTX levels. PHF was negatively correlated with lumbar BMD, femoral neck BMD, blood calcium (Ca), P, and OC levels, and was positively correlated with 25OHD and β-CTX levels. In male participants, PMOF was negatively correlated with lumbar BMD and femoral neck BMD. PHF was negatively correlated with femoral neck BMD. Among female participants, both PMOF and PHF were negatively correlated with lumbar BMD, femoral neck BMD, and blood Ca levels, and were positively correlated with β-CTX levels (all P values<0.05). Conclusion The FRAX values are not only related to BMD, but also related to a number of bone metabolism biochemical markers. The correlation between the FRAX values and bone resorption marker β-CTX is more precise than the bone formation marker OC. Therefore, the combination of FRAX with BMD and bone metabolism biochemical markers may better predict the risk of osteoporotic fractures.
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