绝经后股骨颈骨折股骨头骨铁含量、血清铁蛋白与骨密度相关性研究

Correlation between femoral head bone iron content, serum ferritin and bone mineral density of postmenopausal wom- en with femoral neck fragility fracture

目的探讨女性绝经后股骨颈骨折股骨头骨铁含量、血清铁蛋白与髋部骨密度的相关性。方法2010年6月至2013年3月，收集156例股骨颈骨折行髋关节置换的绝经后女性患者资料，年龄56--92岁，平~J（72．40~8．97）岁；按每10岁年龄段分组，共分5组，即≤60岁组、61-70岁组、71~80岁组、81-90岁组、391岁组。患者人院后第2天留空腹血清标本测定血清铁蛋白和骨代谢指标；对髋关节置换术后留取的股骨头组织行骨铁含量检测和骨铁染色，术后第10天行髋部和腰椎骨密度（DXA）检测。结果5组之间骨铁、血清铁蛋白、转铁蛋白、总铁结合力、I型原胶原氨基端延长肽、I型胶原c端肽B降解产物、髋部和L。。骨密度存在组间差异。髋部和L，。骨密度随年龄增加而下降，骨铁和血清铁蛋白随年龄增加而升高，骨铁和血清铁蛋白检测值均在81~90岁年龄组达到峰值，156例患者的平均骨铁量为96．81灿g，g，平均血清铁蛋白为235．66μg/L。156例患者中，血清铁蛋白〉200μg／L的患者为100例（100／156，64．1％）。骨铁、血清铁蛋白、年龄、体重指数可进入髋部骨密度回归模型，股骨颈R=O．443，Wards三角砰=O．397，大转子月。=0．322，全股骨R=0．379；控制年龄、体重、体重指数等因素，骨铁和血清铁蛋白与髋部骨密度呈负相关，与腰椎骨密度无明显相关性。结论发生股骨颈脆性骨折的绝经后女性患者体内存在铁蓄积，股骨头骨铁含量随年龄增加而升高，骨铁增加和血清铁蛋白升高可能是髋部骨密度下降的独立危险因素，铁蓄积与绝经后骨质疏松症存在相关性。

Objective To explore the correlation between femoral head bone iron content, serum ferritin （SF） and bone mineral density of postmenopausal women with femoral neck fragility fracture. Methods From June 2010 to March 2013, 156 postmenopausal women with femoral neck fragility fractures aged from 56 to 92 years old, with an average age of 72.40＋8.97 years, were divided into 5 groups based upon the stratification of 10-year age intervals （~60, 61-70, 71-80, 81-90 and 391）. Blood sam- ples were collected to determine iron metabolism and bone metabolic markers after overnight fasting. Bone specimens were ob- tained for detecting bone iron contents and performing iron stain respectively after hip arthroplasty surgery. BMD was measured by dual energy X-ray absorptiometry（DXA）at hip and lumbar spine from L1 to L, ten days after surgery. Results There were signifi- cant differences in the values of bone iron content, SF, transferrin, total iron binding capacity, serum procollagen type I N-terminal propeptide, 13-carboxy terminal telopeptide of collagen type I and BMD at hip and LI to L, in all groups. BM/D at hip and L~ to L~ de- creased while bone iron content and SF increased with age; the peaks of bone iron content and SF were bot]h in 81-90 years group; the average of bone iron content and SF was 96.81 Izg/g and 235.66 p,g/L respectively. There were 100 pa^Lients （100/156, 64.1%） whose SF was over 200 p,g/L. Bone iron content combined with SF, age and BMI could be put into the regression models of BMD at various proximal femur sites （femoral neck R~=0.443, Wards triangle R2=0.397, greater trochanter R~=0.322 and total femur R~= 0.379）. After adjustment of age, weight, BMI and other factors, we found that bone iron content and SF were negatively correlated with BMD at proximal femur, but had no significant correlation with BMD at lumbar spine. Conclusion Iron accumulation is prevalent in postmenopausal women with hip fragility fractures. High bone iron content and SF are independent risk factors for low BMD at proximal femur. These results provide clinical evidences that iron accumulation is associated with postmenopausal osteoporosis.