8O岁及以上男性低骨量和跌倒及脆性骨折的相关因素研究

Prevalence of osteoporosis, osteopenia, fall and brittle fracture and their associated factors in men aged 80 years and over

目的观察80岁及以上生活自理的男性人群骨质疏松、骨量减少、跌倒和脆性骨折的现状并分析相关因素。方法前瞻性研究，连续入选年龄≥80岁自理能力良好男性184例。问卷包括生活习惯、基础疾病、相关症状和服药情况。检测骨密度、握力、步速、计时起走测试、站起试验、骨转换标志物、相关激素水平、生化指标。二元Logistic回归分析骨质疏松、骨量减少、跌倒和脆性骨折相关因素。结果184例入选者骨质疏松症患病率为12．5％（23例）、骨量减少45．1％（83例）。骨质疏松组较骨量正常组的身高、体重和体质指数低，I型前胶原氨基末端肽、I型胶原羧基末端肽含量高（P〈0．05或P％0．01）；骨质疏松和骨量减少组的雌二醇水平低于骨量正常组（P〈0．05）。骨质疏松和低骨量与吸烟、体重减轻和S-CTx值升高相关（OR值分别为3．607、0．823和12．427，均P〈0．05）。80岁后有跌倒史者占55．4％（102例），脆性骨折发病率12．0％（22例），骨质疏松、骨量减少、骨量正常组分别为17．4％（4／23）、18．1％（15／83）和3．8％（3／78）。脆性骨折的发生与全髋骨密度值减低和80岁后跌倒相关（0R值分别为0．017和13．126，均P％0．05）。结论80岁及以上生活自理男性人群骨质疏松的初级预防和二级预防需要从生活指导、跌倒预防和药物治疗等多方面进行综合干预。

Objective To investigate the prevalence of osteoporosis, osteopenia, fall and brittle fracture and their associated factors in men aged 80 years and over. Methods In a prospective study, 184 study subjects with good self-care ability aged 80 years and over were enrolled. The questionnaire included living habits, fails, comorbidities, related symptoms and medicines. The bone mineral density, hand grip strength,gait speed, timed up and go test（TUG）, chair rising test（CRT）, bone turnover markers and related hormones were measured. Binary Logistic regression model was used to analyze associated factors for osteoporosis, osteopenia, fall and brittle fracture. Results The prevalence of osteoporosis （OP）and osteopenia（OPA） were 12.5 % （23/184） and 45.1 % （ 83/184）respectively in this study. The height, weight and body mass index were lower, and serum levels of procollagen type 1 N-terminal propeptide（PlNP）and C-telopeptides of type 1 collagen（s-CTx）were higher in osteoporosis group than in normal bone mass（NBM） group（P〈0. 05 ,P〈0. 01）. The estradiol levels were lower in OP and OPA group than in NBM group（P〈 0. 05）. The risk factors for OP and OPA included smoking（OR = 3. 607, P%0.05）, decreased body weight （OR=0. 823,P〈0. 05） and elevated S-CTx level（OR = 12. 427, P〈0. 01）. 55.4% （102/184） of study subjects had fall history after 80 year-old. The prevalence of fragile fracture was 17.4 % （4/23）, 18. 1 G （15/ 83）and 3.8% （3/78）in OP, OPA and NBM groups respectively, with total prevalence of 12.0G （22/184）. The risk factors for fragile fracture were a decreased total hip BMD（OR= 0. 017,P〈0.05）and fall history after 80-year-old（OR = 13. 126, P〈0.05）. Conclusions Based on associated factors of osteoporosis, osteopenia,falls and fragile fracture in male aged 80 years and over,the primary and secondary prevention of osteoporosis may need a comprehensive geriatric intervention including lifestyle adjustment, fall prevention and pharmacologic treatments.