老年骨折患者25-羟基维生素D和甲状旁腺素与骨质疏松程度的相关性

Correlation between serum 25-hydroxy vitamin D, parathyroid hormone and osteoporosis in elderly fracture population

目的了解老年骨折患者25-羟基维生素D[25OHD]和甲状旁腺激素的状况,分析其与骨质疏松程度的关系,为防治骨质疏松性骨折提供依据。方法 2011年8月至2012年6月在北京友谊医院治疗的老年骨折患者146例(男性36例,女性110例)纳入本研究,患者年龄60～90岁,平均年龄(72.4±9.2)岁。采用酶联免疫分析法测定血清25OHD和PTH水平,根据血清25OHD水平将患者分为维生素D严重缺乏组(<10ng/mL)、缺乏组(≥l0<20ng/mL)、不足组(≥20<30ng/mL)和充足组(≥30ng/mL);根据PTH水平将患者分为不足组(<8.3pg/mL)、正常组(≥8.3≤68pg/mL)、增高组(>68pg/mL)。同时应用双能X线骨密度仪测定腰1-4及股骨近端(全髋、股骨颈)的骨密度。腰1-4、全髋、股骨颈任意一个部位骨密度T值>-1为正常组,骨密度T值为-1～-2.5为骨量减少组,≤-2.5为骨质疏松组。对男女患者间的年龄、体重指数、25OHD、PTH及以及骨密度的差异进行描述性统计分析和独立样本t检验。对不同组间25OHD、PTH水平及骨密度差异进行单因素方差分析;对25OHD及PTH与腰1-4、全髋、股骨颈骨密度进行相关性分析。结果 146名老年骨折患者中维生素D严重缺乏者41例(28.1%),缺乏者83例(56.8%),不足者18例(12.3%),充足者仅4例(2.7%)。PTH水平增高组44例(30.1%),正常组102例(69.9%),不足组0例(0%);骨密度正常组16例(11.0%),骨量减少组48例(32.8%),骨质疏松组82例(56.2%)。女性患者维生素D严重缺乏组股骨颈的骨密度显著低于维生素D缺乏组(P<0.05)。不同骨密度组间的25OHD差异无统计学意义(P>0.05);PTH差异有统计学意义(P<0.05)。血清25OHD与PTH无明显相关性。老年骨折患者25OHD与腰1-4骨密度呈正相关,相关系数为0.394(P<0.05)。女性患者25OHD与腰1-4和股骨颈呈正相关,相关系数分别为0.392(P<0.05)和0.432(P<0.05)。男性患者25OHD和PTH与腰1-4、全髋和股骨颈骨密度均无明显的相关性。结论老年骨折人群中存在严重维生素D缺乏状况,女性患者尤为严重;同时存在PTH增高现象。25OHD与骨密度间存在相关性。

Objective To determine the serum Vitamin D （25OHD） and parathyroid hormone （PTH） status in eldery fracture population and estimate its correlation with bone mineral density （BMD）. Methods From 2011.8 to 2012. 6, totally 146 patients treated in our hospital were involved in this study, including 36 male and 110 female pa- tients. The serum 25OHD and PTH levels of all participants were measured by euzymelinked immunosorbent assay. Sim-ultaneously, BMD at lumbar spine 1-4（ L1-4 ） and hip sites were measured by Dual-energy X-ray energy absorptiometry （DXA）. Serum Vitamin D status was classified into 4 groups according to serum 25OHD levels, severe deficiency （ 〈 10 ng/mL）, deficiency （ 10≤25OHD 〈20 ng/mL）, insufficiency （20≤25OHD 〈30 ng/mL） and suffjciency （ ≥ 30 ng/mL）, meanwhile dividing PTH status into 3 groups according to its levels , insufficiency （ 〈 8. 3 pg/mL）, nor- mal （8. 3 ≤ PTH ≤ 68 pg/mL）, elevated （ 〉 68 pg/mL ）. The participants were divided into 3 groups according to Bone mineral density, T 〉 - 1 was defined as normal group, - 1 〈T 〈 -2. 5 was defined as osteopenia group, T≤ -2. 5 was defined as osteoporusis group. Results Among the 146 patients, including 36 male and 110 female , the level of vitamin D severe deffciency, deficiency, insufficiency and sufficiency were 41 cases （28. 1% ）, 83 cases （56. 8% ）, 18 cases （ 12. 3% ） and d cases （2. 7% ）, respectively. Normol level of PTH was 102 case （69. 9% ）, elevated group was 44 case （30. 1% ） ; Normal bone mineral density group was 16 case （ 11.0% ）, bone mass reduced group was 48 case （32. 8% ）, osteoporosis group was 82 case （56. 2% ）. The T-scores at femora neck of females between serum 25OHD severe deficiency group and deficiency group are significant difference. There were no significant difference of 25OHD levels between BMD groups （P 〉0. 05）, but PTH levels between BMD groups were significant difference （P 〈 0. 05）. Association was found between 25OHD level and BMD at lumbar spinel 4 in all patients, and was not found be- tween 25OHD and PTH levesl. Association was found between 25OHD level and BMD at femoral neck and lumbar spine in female. Conclusion Vitamin D deficiency and insufficiency is a quite serious problem in eldery people with fracture. PTH increased in eldery population with fracture. Association was found between 25OHD level and BMD.