湖州市住院老年精神障碍患者骨量减少和骨质疏松的发生率及骨密度下降的相关因素(英文)

Prevalence of osteopenia and osteoporosis and factors associated with decreased bone mineral density in elderly inpatients with psychiatric disorders in Huzhou,China

背景 国内对住院的老年精神障碍患者骨折风险的研究较少。目的 评估老年精神障碍患者的骨密度(bone mineral density, BMD),探明骨密度降低、骨量减少(osteopenia )和骨质疏松(osteoporosis)的相关因素。方法 随机选取湖州市第三人民医院老年科精神障碍住院患者(60岁或以上,诊断为精神分裂症、抑郁症、双相障碍或痴呆)102例。采集患者详细的人口学资料、临床资料、身高和体重指数等,采用双能X射线吸收测定法(dual energy X-ray absorptiometry,DXA)测定腰椎的骨密度。根据世界卫生组织的标准,将低于健康成人平均骨密度1～2.5个标准差者判定为骨量减少,将低于2.5个标准差以上者判定为骨质疏松。结果 骨量减少的发生率为 33.3%(95%CI,24.4%～43.2%),骨质疏松的发生率为 35.3%(26.0%～45.2%),所有这些患者均没有因骨密度降低而接受相应治疗,即便是 5 例曾发生过非外伤性骨折的患者也不例外。女性骨质疏松的发生率是男性的 10 倍(53%比5%)。骨密度随年龄的增加而下降,但随体重指数的增加而增加(患者营养状况改变的结果)。抑郁症患者骨质疏松的发生率(58%)远远高于精神分裂症(33%)、阿尔茨海默病(30%)以及双相障碍(13%)的患者。将骨量减少、骨质疏松患者合并为一组后回归分析发现,低骨密度和合并组均与女性、年龄大、体重指数低及抑郁症诊断独立相关。骨密度下降及骨质疏松与规律服用抗精神病药不相关。结论 骨量减少和骨质疏松是老年精神障碍患者常见的问题,会严重影响其生活质量,但这些问题往往没有得到诊治。需要进一步开展长期的前瞻性研究,以便阐明营养状况、活动量、药物使用及其他因素在精神疾病与骨密度下降之间的病因学通路中所起的重要作用。

Background：Little is known about the risks of bone fractures in elderly patients with mental disorders in China.Aim：Assess the bone mineral density（BMD） of elderly patients with mental disorders in China and identify factors that are associated with low BMD,osteopenia and osteoporosis.Methods：one hundred and two psychiatric inpatients 60 years of age or older（including patients with schizophrenia,depression,bipolar disorder and dementia） were randomly selected from patients in the geriatric wards of the Third People＇s Hospital of Huzhou.Detailed demographic,clinical and biometric data were obtained and the BMD of the lumbar spine was assessed using standard dual energy X-ray absorptiometry（DXA） procedures.Based on WHO criteria,individuals with BMD 1 to 2.5 standard deviations below the mean value for healthy young adults were diagnosed as osteopenia and those with BMD values 2.5 or more standard deviations below the mean value were diagnosed as osteoporosis.Results：The prevalence of osteopenia was 33.3%（95% CI,24.4%-43.2%） and the prevalence of osteoporosis was 35.3%（26.0%-45.2%） but none of these patients-even the five patients who had had non-traumatic fractures-had ever been treated for these conditions.The prevalence of osteoporosis in females was 10-fold that in males（53% versus 5%）.BMD decreased with age and increased with increasing body mass index（a reflection of nutritional status）.The prevalence of osteoporosis was much higher in patients with a diagnosis of depression（58%） than in those with schizophrenia（33%）,Alzheimer＇s disease（30%） or bipolar disorder（13%）.Regression analyses found that low BMD and the combined category of osteopenia and osteoporosis were both independently associated with female gender,increasing age,decreasing body mass index,and a diagnosis of depression.BMD and osteoporosis were not significantly associated with regular use of antipsychotic medication.Conclusion：Osteopenia and osteoporosis are common conditions in elderly patients with mental disorders that can seriously affect their quality of life but they often go undiagnosed and untreated.Long-term prospective studies are needed to clarify the relative importance of nutritional status,activity level,medication usage,and other factors in the causal pathways that connect mental illnesses to BMD.