沈阳地区不同年龄组、体质量指数女性人群髋关节骨密度的流行病学分析

Epidemiological analysis of hip bone mineral density in women of different age groups and body mass index in Shenyang area

目的探讨沈阳地区人群骨质疏松症流行病学情况。方法整群抽样2013-2016年在中国医科大学附属盛京医院进行骨密度检查的4057例女性人群为研究对象,年龄16~90岁,采用Norland公司生产的XR-600型骨密度仪,检测受试者左侧髋关节股骨颈、大粗隆及Ward’s三角区的骨密度(bone mineral density,BMD)T值、BMD值及一般资料的调查。将检测结果以髋关节各部位T值分组,按年龄和体质量指数(body mass index,BMI)进行分层,对不同分组情况的骨质疏松程度进行统计分析和对比。结果 1)本次检测的4057例调查女性人群在左侧髋关节3个部位(股骨颈、大粗隆、Ward’s三角区)中,不同年龄和BMI的T值和BMD值差异都有统计学意义(P<0.001)。在≤39岁和40~49岁的年龄段,在3个部位BMD和T值的差异无统计学意义(P>0.05),>49岁的人群中,以每10岁为一个年龄段,BMD和T值下降的速度比较显著。(2)不同年龄组Ward’s三角区、大粗隆股骨颈BMD值和T值差异有统计学意义(P<0.001)。(3)骨质疏松的人群中,大粗隆的部位出现骨质疏松情况的平均年龄为(65.85±10.65)岁,股骨颈部位为(72.08±9.36)岁,Ward’s三角区部位为(63.56±10.23)岁。(4)应用卡方检验,高BMI人群股骨颈骨质疏松率为0.6%,正常BMI人群为3.4%,低BMI人群为13.1%,差异有统计学意义(P<0.001);高BMI、正常BMI和低BMI大粗隆部位骨质疏松率分别为8.6%、18.8%和53.6%(P<0.001)。结论 1)在>49岁的人群中,髋关节3个部位骨矿物含量下降速度均较快。(2)随着年龄的增加,Ward’s三角区的BMD值和T值下降的速度最早最快,大粗隆部位和股骨颈部位的BMD和T值相对较高,降低的速度也较慢。(3)骨质疏松的人群中,大粗隆的部位出现骨质疏松情况的平均年龄最高,其次为股骨颈部位,平均年龄最低的为Ward’s三角部位。(4)低BMI的人群3个部位的骨质疏松率显著较高。在股骨颈部位和大粗隆部位,高BMI的人群中出现骨质疏松的人数远低于低BMI的人群。

Objective To investigate the prevalence of osteoporosis in 4057 female patients of Shengjing Hospital in Shenyang City,Liaoning province. Methods 4057 female cases aged 16-90 years,who had bone density examination in our hospital from2013 to 2016,were chosen as the research subjects. Bone mineral density was measured using Norland XR-600 bone densitometer.T-score and BMD of three regions of left hip were obtained,and at the same time data on height,weight,age and other information were collected. Participants were grouped according to T-score of different hip regions,age and BMI for statistical analysis.Results 1） 4057 women were included in the study. BMD and T-score of the three regions of left hip（femoral neck,greatertrochanter,and Ward’s triangle area） were significantly different by age and BMI（P 〈 0. 001）. Between the age groups of ≤39 years and 40-49 years,there were no significant differences in BMD and T-score of the three regions of hip（P 〉 0. 05）. In those aged above 49 years,with every 10 years of increase in age,BMD and T-score decreased significantly.（2） BMD and T-score of Ward’s triangle,greater trochanter and femoral neck of different age groups were significantly different（P 〈 0. 001）.（3） In the osteoporotic population,the mean age of osteoporosis in the trochanteric region was 65. 84 ± 10. 65 years,of the femoral neck was72. 08 ± 9. 36 years,and of the Ward’s triangle was 63. 56 ± 10. 23 years.（4） Using chi-square test,femoral neck osteoporosis rate in the high BMI group was 0. 6%,in the normal BMI group 3. 4%,and in the low BMI group 13. 1%（P 〈 0. 001）. The rates for greater trochanter osteoporosis were 8. 6%,18. 8% and 53. 6% in the high,normal ad low BMI groups,respectively（P 〈 0. 001）.Conclusion 1） In the population aged 49 years and above,the bone mass of the three regions of the hip decreased rapidly.（2）With the increase in age,BMD and T-score of the Ward’s triangle area decreased the earliest and fastest,and the BMD and T-score of greater trochanter and femoral neck were relatively higher,with slower rate of decrease.（3） In the osteoporotic population,the average age of osteoporosis at the trochanteric region was the highest,followed by the femoral neck,and the lowest age was the Ward’s triangle.（4） The chi-square test was used to discuss the relationship between BMI and the incidence of osteoporosis. It was found that the osteoporosis rate of the three hip regions in the low BMI population was significantly higher. The prevalence of osteoporosis in the high BMI population was much lower than that in the low BMI population at femoral neck and trochanter.