骨硬化蛋白与绝经后妇女脆性骨折的相关性

Association of sclerostin with fragility fractures in postmenopausal women

目的了解绝经后跌倒骨折妇女及跌倒无骨折妇女人群血液循环中骨硬化蛋白与血清骨代谢标志物、骨密度之间的关系,探讨骨硬化蛋白是否可作为一种新的预测脆性骨折的生化标志物。方法采用横向前瞻性研究,对50例健康的未绝经女性(A组)、50例绝经后跌倒股骨颈骨折妇女(B组)及50例绝经后跌倒无骨折妇女(C组)进行评估,评估内容包括血清骨硬化蛋白水平、骨代谢标志物及骨密度。结果骨代谢标志物如Ⅰ型胶原交联C-端肽(CTX)、CTXⅡ、骨特异性碱性磷酸酶(b-ALP)、前胶原1型N端前肽(P1NP)、核因子κB受体激活因子(RANK)和核因子κB受体激活因子配体(RANKL)在3组间差异均有统计学意义(P<0.05,P<0.01);相较于A组,B组及C组的骨硬化蛋白水平升高(P<0.05,P<0.01)、骨钙素水平降低(P<0.01),但B、C两组间骨硬化蛋白水平和骨钙素水平差异无统计学意义。股骨颈、全髋、转子间及L1~L4部位的骨密度在3组之间差异有统计学意义(P<0.01),B组中骨密度较A、C两组降低(P<0.01)。在所有研究对象中,骨硬化蛋白水平与股骨颈骨密度(r=-0.228,P=0.004)、转子间骨密度(r=-0.199,P=0.002)和全髋骨密度(r=-0.273,P<0.001)均呈负相关。结论绝经后妇女中骨折人群与未骨折人群血清骨硬化蛋白水平差异无统计学意义,提示血清骨硬化蛋白水平无法预测脆性骨折风险。

Objective To determine the relationship between circulating sclerostin levels and serum bone metabolism markers,bone mineral density（BMD）in postmenopausal women with or without fracture after falling,and to explore whether sclerostin can serve as a new biomarker to predict fragility fracture.Methods In this cross sectional and prospective study,50 premenopausal women（group A）,50 postmenopausal women with femoral neck fracture after falling（group B）and 50 postmenopausal women without femoral neck fracture after falling（group C）were included.Observation items included serum sclerostin,bone metabolism markers and BMD.Results There were significant differences in bone metabolism markers（including C-terminal telopeptides of type Ⅰ collagen [CTXⅠ],C-terminal telopeptides of type Ⅱ collagen [CTXⅡ ],bone alkaline phosphatase [b-ALP],procollagen type 1 N-propeptide[P1NP],receptor activator of NF-κB [RANK]and receptor activator of NF-κB ligand[RANKL]）among three groups（P〈0.05,P〈0.01）.The protein levels of sclerostin（P〈0.05,P〈0.01）and osteocalcin（P〈0.01）in the group B and C were significantly higher than that in the group A,but there was no statistical difference between the group B and C.There were significant differences in BMD at the site of lumbar spine（from L1 to L4）,total hip,trochanter or femoral neck among three groups（P〈0.01）,and the BMD in the group B was significantly lower than those in the group A and C（P〈0.01）.There were significant negative correlations between serum sclerostin level and mean femoral neck BMD（r=-0.228,P=0.004）,mean trochanter BMD（r=-0.199,P=0.002）and mean total hip BMD（r=-0.273,P〈0.001）.Conclusion There is no statistical difference in serum sclerostin between postmenopausal women with and without femoral neck fracture after falling,suggesting that serum sclerostin levels may not be used to predict the potential risks of fraglity fracture in postmenopausal women.