老年慢性肾脏病患者骨质疏松发生情况与危险因素

The incidence and risk factors of osteoporosis in elderly patients with chronic kidney disease

目的分析老年慢性肾脏病（CKD）患者并发骨质疏松症后骨密度（BMD）的改变及其与各种危险因素的相关性,为早期诊断、早期防治CKD并发骨质疏松症提供理论依据。方法年龄65岁以上非透析的CKD住院患者,根据2002年K/DOQI指南CKD的定义及分期系统分为CKD 1~2期组、CKD 3期组和CKD 4~5期组。记录临床特征,实验室检查指标,并行双能X线骨密度测量法测定腰椎及股骨BMD。根据受试者的BMD值将CKD患者分为骨质疏松组（OP组）和非骨质疏松组（非OP组）,对比两组CKD患者的性别、年龄、体质量指数（BMI）、血清钙、磷及骨钙素之间的差异,分析其危险因素。结果老年CKD患者骨质疏松发生率高达30.4%,OP组与非OP组比较,女性比率大,BMI及维生素D水平低,血清降钙素水平高。两组间差异均有统计学意义（P〈0.05）。多因素分析,绝经后女性和低BMI是老年CKD患者骨质疏松的危险因素。结论老年CKD患者骨质疏松发生率高,其中,绝经后老年女性和低BMI的老年患者是发生骨质疏松的高危人群。

Objective To evaluate bone mineral density（ BMD） and analyze the incidence and risk factors of osteoporosis in elderly patients with chronic kidney disease（ CKD）. Methods 151 cases of nondialyzed CKD were divided into 3 groups（ CKD stages1-2,CKD stage 3and CKD stages 4-5） on the basis of Kidney Disease Outcome Quality Initiative（ K /DOQI）. All patients received lumbar and femoral BMD test by dual-energy X-ray absorptiometry. Based on BMD,all patients were further divided into osteoporosis group and non-osteoporosis group.Results The incidence of osteoporosis in elderly patients with CKD were 30. 4%,and more common in female patients. Compare to non-osteoporosis group,patients in osteoporosis group had significantly lower body mass index（ BMI）,lower blood vitamin D levels and higher serum calcitonin levels（ all P〈 0. 05）. Conclusion Postmenopausal and low BMI are risk factors of osteoporosis in elderly patients with CKD.