骨质疏松症药物治疗中发生椎体骨折的危险因素

Risk factors of vertebral fracture in drug treatment of osteoporosis

目的探讨骨质疏松症双膦酸盐药物治疗中发生椎体骨折的危险因素。方法选择2015年1月~2021年12月在本院行双膦酸盐治疗期间发生椎体压缩性骨折的患者53例作为研究组,按照1:2的比例选择同期在本院接受双膦酸盐治疗未出现压缩性骨折的患者106例作为对照组。观察患者一般特征、骨密度、治疗前实验室指标、功能测试指标等潜在因素对椎体骨折发生的影响。结果研究组年龄、病程和女性患者比例高于对照组,骨密度低于对照组,差异均有统计学意义(P<0.05)。研究组患者羧化不全骨钙素(ucOC)、骨碱性磷酸酶(BAP)、1型胶原N端肽(NTX)、抗酒石酸酸性磷酸酶5b(TRACP-5b)、同型半胱氨酸(Hcy)、戊糖苷水平高于对照组,25羟维生素D水平低于对照组,差异均有统计学意义(P<0.05)。研究组起立行走试验(TUG)和跌倒风险评估量表评分均高于对照组,睁眼单腿站立测试(OLST)低于对照组,差异均有统计学意义(P<0.05)。多因素Logistic分析显示,年龄≥74岁、戊糖苷≥44.08 pmol/mL、跌倒风险评分≥6分是发生椎体骨折的风险因素(P<0.05),OLST≥24 s是发生椎体骨折的保护性因素(P<0.05)。结论高龄、戊糖苷水平、跌倒风险评分及OLST可能是影响骨质疏松症患者双膦酸盐治疗期间发生椎体骨折的风险因素。

Objective To explore the risk factors of vertebral fracture in bisphosphonates treatment of osteoporosis.Methods Fifty-three patients with vertebral compression fractures during bisphosphonate treatment in our hospital from January 2015 to December 2021 were selected as the study group,and 106 patients without compression fractures who received bisphosphonate treatment in our hospital in the same period were selected as the control group according to the ratio of 1:2.The effects of general characteristics,bone mineral density,baseline laboratory indexes and functional test indexes on the occurrence of vertebral fracture were observed.Results The age,course of disease and the proportion of female patients in the study group were older,longer and higher than those in the control group,and the bone mineral density was lower than that in the control group(P<0.05).The levels of osteocalcin(ucOC),bone alkaline phosphatase(BAP),type 1 collagen N-terminal peptide(NTX),tartrate resistant acid phosphatase 5b(TRACP-5b),homocysteine(Hcy)and pentoside in the study group were higher than those in the control group,and the level of 25 hydroxyvitamin D was lower than that in the control group(P<0.05).The scores of standing up walking test(TUG)and fall risk assessment scale in the study group were higher than those in the control group,and the eye opening one leg standing test(OLST)was lower than that in the control group(P<0.05).Multivariate logistic analysis showed that age≥74 years old,pentoside≥44.08 pmol/mL and fall risk score≥6 were the risk factors of vertebral fracture(P<0.05),and OLST≥24s was the protective factor of vertebral fracture(P<0.05).Conclusion Pentoside level,fall risk and OLST may affect the risk of vertebral fracture in patients with osteoporosis during bisphosphonate treatment.These potential factors should be considered before treatment to evaluate the risk of vertebral fracture in patients with osteoporosis.