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| 3608例中老年人骨代谢指标对骨质疏松及骨折风险的预测 |
| Bone metabolic markers predict the risk of osteoporosis and fracture in 3608 middle-aged and elderly patients |
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| DOI：10.3969/j.issn.1006-7108.2024.10.005 |
| 中文关键词: 骨质疏松 FRAX 25(OH)D3 骨钙素N端中分子片段 甲状旁腺素 骨密度 |
| 英文关键词:osteoporosis FRAX 25(OH)D3 N-MID parathyroid hormone bone mineral density |
| 基金项目:国际课题“IOF对骨量减少人群骨折风险评估(FRAX)前瞻性研究”(IOFCJO-D001) ；北京市大兴区预防医学会科研项目（XHKY202405） |
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| 中文摘要: |
| 目的 探讨北京南郊中老年人骨代谢指标与骨密度的相关性，以及在骨质疏松症及骨折风险预测中的价值。方法 以2017年4月至2023年4月在首都医科大学大兴教学医院行骨密度（bone mineral density，BMD）检查的中老年患者3608 例作为研究对象，收集性别、年龄、BMD、25(OH)D3、N-MID、PTH等指标，比较骨代谢指标在不同骨量及性别间的差异，各指标之间的相关性，建立10年主要骨质疏松性骨折风险(FRAX-MOF)和髋部骨折风险（FRAX-HF）回归方程，绘制不同指标诊断骨量减少或骨质疏松的ROC曲线。结果 女性FRAX骨折风险高于男性，女性在各骨量组的N-MID高于男性但25(OH)D3含量低于男性，年龄、N-MID与BMD呈负相关（r=-0.87），与MOF、HF呈正相关（年龄：r=0.87和0.96，N-MID：r=0.87和0.77）。BMI与BMD呈正相关（r=0.67），与MOF、HF呈负相关（r=-0.67和-0.70），差异均有统计学意义。构建HF回归方程模型：Y=-1.051+0.057年龄-0.222性别-0.041BMI-0.508BMD-0.003 N-MID-0.003 25(OH)D3，R2=0.724，P=0.000。N-MID预测骨质疏松（T值≤-2.5）和骨量减少（T值＜-1）的 AUC值为0.62和0.60，差异有统计学意义。结论 N-MID与BMD有较好的相关性，在骨质疏松和FRAX-HF的早期识别中可能发挥作用。血清25(OH)D3及PTH对于骨量变化及骨折风险的识别价值，可能更需要结合性别、年龄及基础疾病等情况综合考虑。 |
| 英文摘要: |
| Objective Investigate the relationship between bone density，bone metabolism markers in middle-aged and elderly from southern suburban Beijing，and their predictive value for osteoporosis and fracture risk. Methods Analyzed data from 3,608 subjects undergoing BMD tests between April 2017-April 2023，including gender，age，BMD，25(OH)D3，N-MID，PTH and so on. Explored differences in bone metabolism markers across bone mass levels，genders，and their correlations. Developed regression models for 10-year FRAX-MOF and FRAX-HF，and ROC curves for osteoporosis and osteopenia. Results The FRAX fracture risk was higher in women than in men. Women had higher N-MID but lower 25(OH)D3 levels than men，with statistically significant differences. Age negatively correlated with BMD (r=-0.87) and positively with MOF and HF (Age：r=0.87, 0.96，N-MID：r=0.87, 0.77)，while BMI was positively correlated with BMD (r=0.67) and negatively with MOF and HF (r=-0.67，-0.70). A regression model for HF was Y = -1.051 + 0.057 Age - 0.222Gender - 0.041 BMI - 0.508 BMD - 0.003 N-MID - 0.003 25(OH)D3, with R2 = 0.724，P<0.001. For osteoporosis and osteopenia，N-MID showed significant AUC values of 0.62 and 0.60，respectively. Conclusion N-MID correlates well with BMD，indicating potential in early osteoporosis and FRAX- HFdetection. The efficacy of 25(OH)D3 and PTH in assessing bone mass changes and fracture risk should be evaluated alongside demographic and health factors. |
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