老年患者25(OH)D、PTH与骨折的相关分析

Correlation analysis of 25(OH) D,PTH,and the fracture in the elderly patients in orthopedic department

目的了解骨科老年患者25-羟基维生素D（25（OH）D）、甲状旁腺激素（PTH）水平及与骨折的相关性。方法2011.8~2014.12我院骨科老年患者428名,72.47±6.19岁,其中骨折192名。测定血清25（OH）D和PTH,腰椎（L1-4）、全髋、股骨颈骨密度。比较骨折与非骨折组25（OH）D,PTH及骨密度的差异;分析25（OH）D、PTH各组骨折和骨密度的差异;分析25（OH）D和PTH、骨密度的相关性;用相对工作特征曲线（relative operating characteristic,ROC curve）分析25（OH）D对骨折的预测价值。结果骨折组与非骨折组相比,25（OH）D水平及全髋和股骨颈骨密度偏低。不同25（OH）D水平组骨折发生的差异具有统计学意义,维生素D严重缺乏组、缺乏组骨折发生率较高。维生素D严重缺乏组、缺乏组、不足组的骨密度偏低,PTH增高组骨密度也偏低。25（OH）D与PTH、腰椎（L1-4）、全髋、股骨颈BMD存在相关性。ROC曲线下面积为0.529,不能以25（OH）D的水平预测骨折。结论骨科老年患者存在严重的维生素D缺乏,维生素D缺乏者骨折发生率明显增高,对其应从补充维生素D、预防跌倒、提高骨质量等多方面进行综合干预。

Objective To determine the serum vitamin D（ 25（ OH） D） and parathyroid hormone（ PTH） status of elderly patients in orthopedic department and to estimate its correlation with fractures. Methods From August 2011 to December 2014,a total of 428 patients treated in our hospital were involved in this study. The average age was 72. 47 ± 6. 19 years old. Among them,192 patients were fractured. Serum 25（ OH） D,PTH,and bone mineral density（ BMD） of the lumbar spine（ L1-4）,total hip,and femoral neck were measured. The differences of 25（ OH） D,PTH,and BMD between fracture group and non-fracture group were compared and analyzed. The correlation among 25（ OH） D,PTH,and BMD was analyzed. Relative operating characteristic curve（ ROC curve） was applied to analyze the predictive value of 25（ OH） D for fractures. Results The 25（ OH） D level and BMD of the hip and femoral neck were lower in fracture group than those in non-fracture group. There was statistical difference of fracture onset among groups with different 25（ OH） D levels. Fracture incidence was higher in vitamin D severe deficiency group and deficiency group. BMD was low in severe deficiency group,deficiency group,and insufficiency group. BMD was low in PTHincreased group. 25（ OH） D was correlated with PTH and BMD of the lumbar spine（ L1-4）,total hip,and femoral neck. The area under ROC curve was 0. 529,indicating that the level of 25（ OH） D could not predict fractures. Conclusion Vitamin D deficiency is a serious problem in elderly patients in orthopedic department. The incidence of bone fractures significantly increases in people with vitamin D deficiency. Supplement of vitamin D,prevention of fall,and increase of bone quality should be applied in the elder people.