应用双能X线骨密度仪调查中国人群骨密度水平和骨质疏松症患病率--多中心大样本体检人群调查

Prevalence of osteoporosis in China: a multicenter;large-scale survey of a health checkup population

目的采用双能X线骨密度仪(DXA)调查我国不同地区成年体检人群平均骨密度水平和50岁以上人群骨质疏松症患病率。方法选取2008—2018年在全国7家三甲医院参加健康体检且年龄在20岁以上的受检者75321人,采用GE Lunar Prodigy或iDXA型号DXA扫描仪测量腰椎1~4、股骨颈和全髋骨密度,用同一欧洲脊椎体模(ESP)在每台DXA机器上重复扫描10次并分别构建每个中心的回归方程校正骨密度值。每5岁为一个年龄组,计算峰值骨量,以平均峰值骨量和标准差计算T值。骨质疏松症的诊断参考世界卫生组织推荐的诊断标准。骨质疏松症总患病率根据2010年全国人口普查数据进行年龄标准化。结果最终纳入研究对象共75321人,其中男性40944人(54.36%),女性34377人(45.64%);总体年龄(51.8±10.9)岁,男性和女性年龄分别为(51.1±10.6)岁和(52.7±11.1)岁。各测量部位平均骨密度值随着年龄增长呈下降趋势,从东北地区、华北地区、华东地区到西南地区呈递减趋势,随着体质指数水平增加呈上升趋势(P均<0.001)。男性峰值骨密度出现在20~30岁,腰椎1~4、股骨颈和全髋峰值骨密度分别为1.09g/cm^2、0.97g/cm^2和0.97g/cm^2;女性峰值骨密度值出现在35~40岁,腰椎1~4、股骨颈和全髋峰值骨密度分别为1.11g/cm^2、0.84g/cm^2和0.88g/cm^2。骨质疏松症患病率最高的部位男性为股骨颈(4.58%),女性为腰椎1~4(23.38%)。50岁以上人群年龄标准化的骨质疏松症总患病率男性为6.46%,女性为29.13%。按照2010年全国人口普查数据,骨质疏松症患者男性10879115例,女性49286542例。结论我国20岁以上体检人群骨密度水平与性别、年龄、地区和体重水平相关。全国50岁以上人群中男性和女性年龄标准化骨质疏松症患病率分别为6.46%和29.13%。

Objective The present study aimed to establish a bone mineral density (BMD) reference database in China and to investigate the prevalence of osteoporosis in Chinese adults aged 50 years and older using dual energy X-ray absorptiometry (DXA). Method A total of 75321 examineers over 25 years old who underwent health checkups in 7 health check centers between 2008 and 2018 were included. All centers used a GE Lunar-DXA system to measure BMD of the lumbar spine (L1-L4), femoral neck, and total femur. The same European Spine Phantom (ESP) was used for scanning 10 times at every center, a regression equation was generated, and BMD data were cross-calibrated in each center. Peak BMD and standard deviation (SD) were identified according to 5-year age groups, and T scores were calculated based on the peak BMD and SD. Osteoporosis was defined according to the World Health Organization criteria. The prevalence of osteoporosis was standardized based on 2010 national census data for the Chinese population. Result The mean BMD values decreased with age, were highest in North China, followed by Northeast China, East China, and Southwest China, respectively, and increased with body mass index. Males aged 20-30 years and females aged 35-40 years had peak BMD values. Peak BMD values of the lumbar spine, femoral neck, and total femur were 1.09 g/cm2, 0.97 g/cm2, and 0.97 g/cm2 in males, and 1.11 g/cm2, 0.84 g/cm2, and 0.88 g/cm2 in females, respectively. Among all scanned sites, the prevalence of osteoporosis was highest in the femoral neck in males (4.58%) and in the lumbar spine in females (23.38%). The age-standardized prevalence of osteoporosis at any site was 6.46% in males and 29.13% in females aged 50 years and older. Based on the 2010 national census data, 10879115 males and 49286542 females currently have osteoporosis. Conclusion Mean BMD values varied according to geographic region, body mass index, age group, and sex in Chinese adults. The age-standardized prevalence of osteoporosis was 6.46% in males and 29.13% in females aged 50 years and older.