大连地区中老年人25-羟维生素D和同型半胱氨酸与骨质疏松症相关性研究

The Association of serum 25-hydroxyvitamin D and homocysteine with osteoporosis in middleaged and elderly adults in Dalian

目的探讨大连地区中老年人25-羟维生素D[25-hydroxyvitamin D,25(OH)D]、血清同型半胱氨酸(Homocysteine,Hcy)水平与骨密度(Bone mineral density,BMD)及骨质疏松性骨折(Osteoportic fracture,OPF)的相关性。方法本研究为横断面研究。210例(男85例,女125例)研究对象均来自我院门诊及体检中心,年龄46-90岁。所有研究对象均检测腰椎1-4(Total)(BMD-L)、髋部(Total)(BMD-H)、股骨颈(BMD-N)骨密度和血清25(OH)D、Hcy、钙、磷、镁、碱性磷酸酶。210例分为骨质疏松组,骨量减少组和骨量正常组。应用方差分析和回归分析分别对男性和女性血清25(OH)D、Hcy与BMD及OPF的相关性进行分析。结果男性和女性骨质疏松组25(OH)D均低于骨量减少组和骨量正常组,差异有统计学意义(P<0.05)。多元线性回归分析校正年龄等潜在混杂因素后,25(OH)D与男性BMD-L(P=0.064)、BMD-H(P=0.073)和女性BMD-H(P=0.072)近似正相关;25(OH)D<20 ng/m L时,男性25(OH)D与BMD-N呈显著正相关;25(OH)D<15 ng/m L时,女性25(OH)D与BMD-L和BMD-N呈显著正相关。Logistic回归分析显示,女性骨质疏松症患者血清中25(OH)D每增加1 ng/m L骨折风险降低12.8%。女性Ln Hcy在骨质疏松组与骨量正常组和骨量减少组比较差异有统计学意义(P=0.040和P=0.020)。女性Ln Hcy与BMD-N呈负相关,校正年龄后不相关。男性和女性Ln Hcy和25(OH)D均不相关。结论 25(OH)D在不同范围时,大连地区中老年男性和女性25(OH)D与各部位BMD不同程度正相关。维生素D缺乏可能是中老年女性OPF发生的独立危险因素。Hcy不是女性发生OPF的危险因素(女性Hcy和OPF不相关),女性高Hcy与低BMD有一定相关关系,这种相关可能与增龄有关。男性Hcy与BMD不相关。

Objective To investigate the relationships of serum 25-hydroxyvitamin D（ 25（ OH） D） and homocysteine（ Hcy） with bone mineral density（ BMD） and osteoporotic fracture（ OPF） in middle-aged and elderly patients in Dalian. Method 210subjects（ 85 males,125 females）,aged 46-90 years old,were selected from the out-patient clinics and physical examination center of our hospital to participate in this cross-sectional study. Bone mineral density（ BMD） at various skeletal sites,including total lumbar spines（ L1-4）（ BMD-L）,total hip（ BMD-H）,and femoral neck（ BMD-N）,and serum biochemical indices including 25（ OH） D,Hcy,calcium,phosphorus,magnesium and alkaline phosphatase were measured for each patient. These patients were divided into three groups： osteoporosis,osteopenia,and normal bone mass. This study employed statistical analyses including ANOVA and regression analysis to quantify the relationship between 25（ OH） D,Hcy,BMD,and OPF. Results 25（ OH） D in the osteoporosis group was statistically significantly lower than that in the osteopenia group and normal bone mass group（ P〈0. 05） in both males and females. Multiple linear regression analysis showed that,adjusted for age and other potential confounding factors,25（ OH） D was nearly positively correlated with BMD-H in both males（ P = 0. 073） and females（ P = 0. 072） and it was also nearly positively correlated with BMD-L（ P = 0. 064） in males. In addition,when 25（ OH） D levels 20 ng/mL,25（ OH） D was significantly positively correlated with BMD-N in males and when 25（ OH） D levels 15 ng/mL,it was significantly positively correlated with BMD-L and BMD-N in females. Moreover,in females with osteoporosis,logistic regression analysis indicated that the risk for osteoporotic fracture was reduced by 12. 8% for each 1 ng/mL increase in 25（ OH） D. In the comparisons of LnHcy among three groups,a significant difference was found between the osteoporosis and the normal bone mass groups（ P =0. 040）,as well as between osteoporosis and osteopenia groups（ P = 0. 020） in females. Multiple linear regression showed that in female LnHcy was negatively associated with BMD-N. However, after adjusted for age, this relationship did not remain significance. LnHcy and 25（ OH） D were not correlated in both males and females. Conclusion 25（ OH） D and BMD at various skeletal sites are positively associated at different levels of significance in middle-aged and elderly adults in Dalian. Vitamin D deficiency is likely to be an independent risk factor of osteoporotic fractures in middle-aged and elderly women. No association was observed between LnHcy and osteoporotic fracture in women. High Hcy and low BMD in women might be associated and this association is possibly age-related. There was no significant correlation between Hcy and BMD in men.