绝经后女性骨质疏松性椎体骨折与腰椎体骨密度的相关性

The correlation between bone mineral density of the lumbar vertebrae and the vertebral fracture in postmenopausal osteoporotic women

随着我国步入老龄化社会,骨质疏松症的患病率明显升高。骨质疏松症最严重的危害来自骨质疏松性骨折,绝经后女性尤其多见。由于脊柱独特的解剖学和生物力学特点,骨质疏松患者更易发生椎体骨折。骨密度测量是诊断骨质疏松的金标准。本文通过回顾近年来相关文献,探讨腰椎体骨密度检测对绝经后女性骨质疏松性椎体骨折的意义,发现:绝经后骨质疏松性椎体骨折患者的BMD水平比绝经后骨质疏松症但无脊椎骨折者明显减少;绝经后骨质疏松症患者的BMD水平越低,其发生椎体骨折的风险越高;有椎体骨折史的绝经后骨质疏松症患者的BMD水平与发生再次椎体骨折的风险呈负相关。药物干预通常可明显提高绝经后骨质疏松症患者的BMD水平,同时还可减少椎体骨折的发生。尚存在一些不足:腰椎骨密度可能出现假性增高;需进一步探讨预测骨质疏松性椎体骨折的骨密度阈值;药物干预的研究中BMD水平与椎体骨折发生的相关性并没有得到深入研究;缺少大规模的绝经后骨质疏松性椎体骨折的流行病学,现有研究也大都存在病例收集方法不规范、样本量小、年龄分布存在差异等不足。对绝经后骨质疏松性椎体骨折的深入研究需要多学科共同协作。

With the stepping into aging society in our country,the prevalence of osteoporosis increases significantly. The most severe damage of osteoporosis is the osteoporotic fracture,which is often seen in postmenopausal women. Due to the anatomical and biochemical characteristics,vertebral fractures are more often in osteoporotic patients. The measurement of bone mineral density is the golden standard for the diagnosis of osteoporosis. By reviewing the relative articles of recent years,we investigated the effect of lumbar bone mineral density on the vertebral fracture in postmenopausal osteoporotic women. We found that the bone mineral density in postmenopausal patients with vertebral fracture was significantly less than that in postmenopausal women without vertebral fracture. Postmenopausal osteoporotic women with lower bone mineral density had a higher risk to obtain vertebral fracture. The bone mineral density of postmenopausal osteoporotic women with a history of vertebral fracture had a negative association with the risk of recurrent vertebral fracture. Drug intervention significantly increased the bone mineral density and reduced the occurrence of vertebral fracture in postmenopausal osteoporotic women. However,the bone mineral density might give a false increase. It is necessary to further investigate the threshold value of bone mineral density to forecast the occurrence of recurrent vertebral fractures.The association between the vertebral fracture and bone mineral density in postmenopausal osteoporotic women with drug intervention has not been further investigated. Large-scale epidemiology survey in postmenopausal osteoporotic women with vertebral fracture is lack. Irregular methods of case collection,small sample size,and difference of age distribution exist in the present studies. The study of the vertebral fracture in postmenopausal osteoporotic women needs further investigation and multi-disciplinary collaboration.