老年慢性疾病患者骨质疏松的相关因素分析

Investigation of the correlative factors for osteoporosis among senile patients with chronic diseases

目的以患有多种心血管疾病及2型糖尿病老年患者为研究对象，探讨老年患者骨质疏松的相关因素。方法根据骨质疏松的诊断标准，将206例患者分为骨质疏松组及非骨质疏松组，记录一般情况，调查患者患各种心血管疾病情况，测定血清血红蛋白、空腹血糖、糖化血红蛋白（HbA1c）、白蛋白、血尿素、肌酐、钙、磷、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）。以双光能X线骨密度检测仪测量腰椎及双侧股骨颈的骨密度值，分析患者骨密度的相关因素。结果老年女性骨质疏松的患病率（58．7％）明显高于老年男性（38．6％），骨质疏松组患者年龄均高于非骨质疏松组，但差异无统计学意义。骨质疏松组体质指数（BMI）均较非骨质疏松组低（P〈O．05），男性骨密度与BMI呈显著正相关（P〈O．01），女性骨密度与BMI呈正相关，与TC、LDL-C呈负相关。对各项生化指标及合并慢性疾病进行逐步法Logistic回归分析结果显示，男性BMI是骨质疏松的独立危险因素，女性BMI及TC是骨质疏松的影响因素。结论老年慢性病患者体质量越低，骨质疏松的危险性越高。老年女性患者TC与骨密度可能存在相关性，更应该积极地控制血脂，对于降低心血管疾病和骨质疏松风险均有益处。

Objective To investigate the correlative factors for osteoporosis among senile patients with multiple cardiovascular diseases and type 2 diabetes mellitus. Methods 206 patients were divided into osteoporosis （OP） group and non-osteoporosis （non-OP） group according to the diagnosis standards of osteoporosis. The general data were recorded. Clinical history of all kinds of cardiovascular diseases and type 2 diabetes mellitus were detected. Serum levels of hemoglobin （Hb）, glucose （Glu）, glucosylated hemoglobin （HbAlc）, alkaline phosphatase （ALP）, total serum protein （TP）, albumin （ALB）, BUN, creatinine （Cr）, calcium （Ca）, phosphonium （P）, total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C） were detected. Dual-energy X-ray absorptiometry was used to detect the bone mineral density （BMD） of bilateral femoral neck and lumbar spine. The related factors of BMD were analyzed. Results The morbidity of osteoporosis was much higher in elderly females than in elderly males （58.7% w 38.6%）. The osteoporosis patients were older than non-osteoporosis patients in both males and females, although there was no significant difference. The body mass index （BMI） of both gender was much lower in osteoporosis group than in non-osteoporosis group （P〈0.05）. In male patients, BMD was positively correlated with BMI significantly （P〈0.01）. In female patients, TC and LDL-C were higher in OP group than in non-OP group （P〈0.05）. In female patients, BMD was positively correlated with BMI, and negatively correlated with TC and LDL-C. Logistic regression analysis showed that the lower BMI was an independent risk factor for osteoporosis in male patients; BMI and TC were independent risk factors for osteoporosis in female patients. Conclusions In both male and female, senile patients with lower BMI, multiple cardiovascular diseases and type 2 diabetes mellitus have higher risks for osteoporosis. In senile female patients, TC may be correlated with BMD. TC should be reduced to decrease the risks of cardiovascular diseases and osteoporosisin senilefemales.