住院老年患者骨骼肌减少与骨密度的关系

Relationship between skeletal muscle loss and bone mineral density in hospitalized elderly people

目的探讨住院老年患者骨骼肌质量、骨骼肌指数与骨密度的关系,以及骨骼肌减少与骨质疏松的关系,为老年骨质疏松及脆性骨折患者的临床防治开拓新思路。方法连续选取重庆医科大学附属第一医院住院老年患者562例,测量身高、体重,计算体重指数(BMI),利用双能X线骨密度仪(DXA)测量不同部位骨密度(BMD)和T值、四肢骨骼肌质量(ASMM)、骨骼肌指数(RSMI)、脂肪百分比(fat%),用Pearson相关性分析法研究各变量之间的关系,用Logistic回归法研究骨骼肌减少、骨质疏松、脆性骨折的关系。结果不同性别老年患者RSMI均与BMD显著正相关(腰椎:男性r=0.203,P<0.01,女性r=0.165,P<0.01;髋部:男性r=0.253,P<0.01,女性r=0.225,P<0.01),且均与BMI呈高度正相关性(男性r=0.777,P<0.01;女性r=0.791,P<0.01),BMD亦与BMI呈显著正相关(腰椎:男性r=0.319,P<0.01,女性r=0.236,P<0.01;髋部:男性r=0.199,P<0.01,女性r=0.211,P<0.01)。老年女性骨质疏松和脆性骨折患病率明显高于男性,而老年男性骨骼肌减少的检出率则显著高于女性。老年男性骨骼肌减少与骨质疏松存在明显的相关性(β=0.774,P=0.002,OR=2.168),而老年女性二者无明显相关性。结论骨质疏松与骨骼肌减少存在性别差异,老年男性二者存在明显正相关,老年女性二者无显著相关;脆性骨折与骨质疏松及骨骼肌减少均密切相关,增加肌肉量对老年人群骨质疏松及骨折的防治有重要意义。

Objective To investigate the relationship between appendicular-skeletal muscle mass （ ASMM ） , relative skeletal muscle index （RSMI）, and bone mineral density （BMD） in hospitalized elderly people, and the relation-ship between skeletal muscle loss and osteoporosis , exploring new ideas for the prevention of osteoporosis and fragility frac-ture.Methods Height, weight, body mass index （BMI）, ASMM, RSMI, BMD, and T-sore at different sites, fat%were evaluated in 562 elderly from The First Affiliated Hospital of Chongqing Medical University , using dual-energy X-ray absorptiometry （ DXA） .Pearson’s correlation analysis was used to estimate associations between different variables about patient’s general characteristics , and relationships between skeletal muscle loss , osteoporosis and fragility fracture were es-timated by logistic regression analysis .Results RSMI had significantly positive correlation with BMD in both genders （ Lumbar：male r=0.203 , P〈0.01 , female r=0.165 , P〈0.01;Hip：male r=0.253 , P〈0.01 , female r=0.225 ,P〈0.01 ） , and also had highly positive correlation with BMI （ male r=0.777 , P〈0.01 , female r=0.791 , P〈0.01 ）;BMD had significantly positive correlation with BMI （ Lumbar：male r=0.319 , P〈0.01 , female r=0.236 , P〈0.01;Hip：male r=0.199 , P〈0.01 , female r=0.211 , P〈0.01 ） .The prevalence of osteoporosis and fragility fracture were significantly higher in elderly women patients , while men suffered more skeletal muscle loss .Men with skeletal muscle loss had a higher risk of osteoporosis in the elderly （β=0.774 , P=0.002 , OR=2.168 ） , but this relationship does not exist in women （ P〉0.05 ） .Conclusions In the elderly , bone and muscle had close relationship;osteoporosis and skel-etal muscle loss had obvious gender differences：significantly positive correlation in men , and no relationship in women . Fragility fracture had close relationship with both osteoporosis and skeletal muscle loss .Raising muscle mass is significant for the prevention of osteoporosis and fragility fracture .