高龄妇女1637例骨健康状况分析

Investigation on bone health conditions in 1637 aged women

目的探讨高龄妇女骨健康状况。方法将2004年5月至2008年10月在复旦大学附属华东医院进行双能X线骨密度仪测定骨密度（BMD）的60岁以上的妇女1637例按每10岁1个年龄段进行分组，共分为4个组（60～69岁组、70～79岁组、80～89岁组和390岁组），分别比较各组妇女腰椎、髋部BMD，骨折发生率及骨转换标志物水平。结果（1）BMD：腰椎BMD在390岁组为（0．96±0．18）g／cm^2 、80～89岁组为（0．90±0．20）g／cm^2、70—79岁组为（0．81±0．16）g／cm^2、60～69岁组为（0．83±0．14）g／cm^2，其中390岁组、80～89岁组BMD明显高于60～69岁组，差异有统计学意义（P〈0．05）。股骨颈、全髋、大转子及华氏三角区各部位的BMD在≥90岁组分别为（0．60±0．11）、（0．65±0．11）、（0．47±0．09）、（0．37±0．09）g/cm^2；80～89岁组分别为（0．57±0．10）、（0．68±0．13）、（0．48±0．11）、（0．35±0．10）g/cm^2；70～79岁组分别为（0．57±0．10）、（0．69±0．12）、（0．49±0．10）、（0．36±0．11）g／cm^2；60～69岁组分别为（0．63±0．10）、（0．76±0．12）、（0．54±0．10）、（0．45±0．12）g/cm^2；其中髋部各部位BMD70～79岁组、80～89岁组、390岁组均明显低于60～69岁组，差异均有统计学意义（P〈0．05）；（2）骨折发生率：各组妇女≥1次骨折的发生率60～69岁组为34．8％（242／695）、70—79岁组为45．0％（296／658）、80～89岁组为51．3％（137／267）、390岁组为5／17；（3）骨转换标志物：血清骨钙素N端中分子片段（N—midBGP）水平、尿Ⅰ型胶原羧基端肽（CTX）与肌酐（Cr）的比值（CTX／Cr）在390岁组分别为（17±5）μg/L、（106±56）μg/mmol，80～89岁组分别为（17±7）μg/L、（128±99）μg/mmol，70～79岁组分别为（21±14）μg/mmol、（182±173）μg/mmol，60～69岁组分别为（25±13）μg/mmol、（190±168）μg/mmol，其中80～89岁组、70～79岁组N-midBGP水平明显低于60～69岁组，差异有统计学意义（P〈0．05）；80～89岁组CTX／Cr明显低于60～69岁组，差异也有统计学意义（P〈0．05）。结论高龄妇女随年龄增加骨代谢逐渐降低，骨折风险增加；髋部BMD用于诊断高龄妇女骨质疏松症更可靠。

Objective To investigate bone health conditions in 1637 aged women. Methods From May 2004 to October 2008, Bone mineral density（BMD） of 1637 women at age of more than 60 years old were measured by Hologic DephiA dual energy X-ray absorptiometry （DXEA） in Huadong hospital affiliated to Fudan University. All data were compared and analyzed among each group which will be divided by every ten years. Those women were divided into groups on 10 years range. BMD of lumbar vertebral and hip bone, fracture incidence and bone turnover marker were compared and analyzed. Results （ 1 ） BMD： at age of ≥90, 80 -89, 70 -79, 60 -69, BMD of the lumbar vertebral 2 -4（L2-4） values were （0.96 ±0. 18） , （0. 90 ± 0. 20）, （0. 81 ± 0. 16）, （0. 83 ± 0. 14） g/cm2, respectively. There were significantly increased BMD of lumbar of women at the age of 80 -89 and ≥90 year-old compared with those of 60 -69 year-old （ P 〈 0. 05 ）. At age of ≥90,80 - 89,70 - 79,60 - 69 BMD of femur neck, Total, Torch, Ward＇s trianger were （0. 60 ± 0. 11 ）, （0. 65 ± 0. 11 ）, （0.47 ± 0.09 ）, （ 0. 37 ± 0. 09 ） g/cm2 ; at age of 80 - 89 BMD of FN, Total, Torch, Ward＇s trianger were（0. 57 ±0. 10）, （0. 68 ±0. 13）, （0. 48 ±0. 11 ）, （0. 35 ±0. 10） g/cm2 ; at age of 70-79 BMD of FN, Total, Torch, Ward＇s trianger were （0. 57 ±0. 10） , （0. 69 ±0. 12）, （0. 49 ± 0. 10）, （0. 36 ± 0. 11 ） g/cm2 ; at age of 60 - 69 BMD of FN, Total, Torch, Ward＇s trianger were （0. 63 ± 0. 10）, （0. 76 ± 0. 12）, （0. 54 ± 0. 10）, （0. 45 ± 0. 15 ） g/cm2 ; There were significantly decreased in BMD of hip at the age of 70 - 79, 80 - 89, ≥ 90 year-old compared with those of 60 - 69 year-old （P 〈 0. 05）. （2） Fracture incidence ： one time fracture incidence at age of 60 - 69,70 - 79,80 - 89, ≥ 90 were 34. 8 % （242/695） ,45.0% （ 296/658 ）, 51.3% （ 137/267 ）, 5/17. There were increasing trend of fracture in aged women. （3） Bone turnover marker of bone Gla protein （BGP） N-mid （N-midBGP） in serum and C-terminal telopeptide of type I collagen/Cr （CTX/Cr） in urine values were （ 17 ±5） μg/L, （ 106 ±56） μg/mmol at age of more than 90 years , （ 17 ± 7） μg/L, （ 128 ± 99） μg/mmol at age of 80 - 89 years, （21 ± 14） μg/L, （ 182± 173 ） μg/mmol at age of 70 - 79 years, （25 ± 13 ） μg/L, （ 190 ± 168 ）μg/mmol at age of 60 - 69 years. There were significant decreased trends of N-midBGP at age of 70 - 79,80 - 89 compared with that of 60-year （P 〈 0. 05）. There were significant decreased trends of CTX/Cr 80 - 89 compared with that of 60- year （P 〈 0.05 ）. Conclusions There were significant decreased bone metabolism in aged women. The risk of hip fracture is significantly increased in aged women. Diagnosis of osteoporosis based on BMD of hip in aged women is more reliable.