广州市多社区1529名中老年人骨质疏松患病率及骨质疏松性骨折发生率分析

Prevalence of osteoporosis and incidence of osteoporotic fractures in 1529 middle-aged and elderly adults in Guangzhou communities

目的调查了解广州市社区中老年人骨量减少、骨质疏松症(osteoporosis,OP)的患病率及骨质疏松性骨折发生率,分析近年来骨质疏松患病率的增减趋势。方法采用现场问卷调查了解受试者的基本资料(包括性别、年龄、身高、体重、骨折史等),并用美国双能X线骨密度仪测量1529例40～87岁中老年人群的腰椎正位和左髋部骨密度(bone mineral density,BMD),以性别、年龄分组进行分析。结果随着年龄递增,各组髋部BMD值逐渐下降,而腰椎BMD值并未随着增龄而呈现递减的趋势,60岁以上中老人髋部BMD值显著低于腰椎BMD值(P<0.05)。根据腰椎BMD值计算,中老年人OP总患病率为30.7%,其中女性为34.2%,明显高于男性的17.9%(P<0.05)。低骨量(osteopenia,OPA)总患病率为41.8%,男女分别为42.4%和41.6%(P>0.05)。根据髋部BMD值计算,OP总患病率更高,达到38.2%,女性为39.4%,高于男性的33.9%(P<0.05)。OPA总患病率为47.4%,男性为52.7%,女性为46.0%(P>0.05)。受调查的中老年男性中有骨折史的为82例,女性为357例,OP患者骨折发生率为37.8%,远高于非OP患者23.1%(P<0.01),再骨折发生率OP患者为6.2%,高于非OP患者的2.64%(P<0.01)。结论广州市社区中老年人骨质疏松患病率和脆性骨折发生率较高,且其发生率均较以往有明显增高的趋势,建议早筛查、早诊断、早治疗。根据髋部BMD值进行骨质疏松评估的敏感性更高,应该首选髋部作为骨密度测量的部位。

Objective To investigate the prevalence rate of osteopenia(OPA)and osteoporosis(OP)and incidence of osteoporotic fractures in middle-aged and elderly adults in Guangzhou community,and to analyze the trend of osteoporosis prevalence in recent years.Methods Data on gender,age,height,weight,fracture history,etc.were collected by handling out questionnaires.BMD of lumbar vertebrae and left hip were measured by dual energy X-ray absorptiometry(DEXA)in 1529 individuals(aged 40-87 years).Statistical analyses were performed by gender and age groups.Results Hip BMD of each group decreased gradually with increasing age,while BMD of lumbar spine did not show a decreasing trend with age.Hip BMD was significantly lower than lumbar spine BMD in those aged over 60 years(P<0.05).According to the lumbar spine BMD value,the total prevalence rate of OP in the community was 30.7%,with significantly higher prevalence rate in females than in males(34.2%vs 17.9%,P<0.05).The overall prevalence rate of OPA was 41.8%,42.4%in males and 41.6%in females,and there was no significant difference between the two groups.According to the hip BMD value,the prevalence of OP was higher and reached 38.2%in the total population;in women it increased to 39.4%,higher than the 33.9%in men(P<0.05).The overall prevalence rate of OPA was 47.4%,52.7%in males and 46.0%in females(P>0.05).Among the investigated middle-aged and elderly adults,there were 82 cases of fracture in men and 357 cases of fracture in women.The incidence of fracture in OP patients was 37.8%,much higher than the incidence in non-OP patients of 23.1%(P<0.01).The incidence of secondary fractures was 6.2%in OP patients,higher than the incidence in non-OP patients of 2.64%(P<0.05).Conclusion The prevalence rate of osteoporosis and incidence of fragility fracture in middle-aged and elderly adults in Guangzhou community was high,and its incidence rate was higher than that in the past.Early screening,early diagnosis and early treatment should be recommended.The sensitivity of osteoporosis assessment based on hip BMD was higher;hip should be the first preferred site for BMD measurement.