女性骨密度的地区差异及多中心参考数据库对诊断骨质疏松的影响

Geographic differences in female bone mineral density and the effect of multi-center reference database on the diagnostic osteoporosis

目的了解我国大陆女性骨密度(bone mineral density,BMD)的地区差异及多中心融合参考数据库对诊断骨质疏松的影响。方法女性参考人群10 343名,年龄范围20~89岁,分别来自长沙、北京、南京、上海、嘉兴、广州和成都地区。除长沙地区1 157名外,其他资料均由通用电气医疗集团(GE Health care)公司提供。受试者均采用GE-Lunar系列DXA骨密度仪测量腰椎和股骨颈BMD。结果 8种不同回归模型分析显示,BMD随年龄变化均采用3次回归模型拟合优度最佳,拟合曲线的决定系数(R^2)为0. 149~0. 546(P均=0. 000)。腰椎BMD随年龄变化的最佳拟合曲线,北京与成都女性之间的差异最大[(12. 9±4. 9)%],北京与南京女性之间的差异最小[(3. 0±3. 4)%];各地区女性之间,股骨颈BMD拟合曲线的差异相对较小。与多中心融合BMD参考数据库比较,北京地区数据库对腰椎骨质疏松的检出率显著升高(17. 5%vs 12. 2%,P=0. 028),嘉兴(23. 9%vs 30. 3%,P=0. 001)、长沙(30. 4%vs 35. 9%,P=0. 037)和成都(34. 8%vs 41. 0%,P=0. 032)地区数据库对骨质疏松的检出率显著降低。结论我国大陆女性BMD存在地区差异,特别是腰椎BMD。提示我国需要建立多个区域性BMD参考数据库。

Objective To understand the geographic differences of bone mineral density(BMD) in women and the effect of using a multi-center combined reference database for diagnosing osteoporosis. Methods The reference population comprised 10 343 females, aged 20-89 years old, from Changsha, Beijing, Nanjing, Shanghai, Jiaxing, Guangzhou, and Chengdu. Except for Changsha(n=1 157), data were obtained from the GE Health Care service. Lumbar spine and femoral neck BMD was measured in the subjects using a bone densitometer(GE-Lunar DXA series). Results Data were analyzed using eight different regression models. We found that the cubic regression model was the best for describing age-related changes in BMD. The coefficients of determination(R2) of the fitting curve were 0.149 to 0.546(all P=0.000). For the best-fit curve of lumbar spine BMD with age, the minimal difference was between Beijing and Nanjing(3.0%±3.4%), and the maximal difference was between Beijing and Chengdu(12.9%±4.9%). The differences in curve values for femoral neck BMD were relatively small between regions. Compared with the multi-center combined BMD database, the detection rate for lumbar spine osteoporosis was higher by using the Beijing database(17.5% vs. 12.2%, P=0.028), and the rates were lower by using the Jiaxing(23.9% vs. 30.3%, P=0.001), Changsha(30.4% vs. 35.9%, P=0.037) and Chengdu databases(34.8% vs. 41.0%, P=0.032). Conclusion There are geographic differences in female BMD in China's Mainland, especially for lumbar spine BMD, so multiple regional BMD reference databases should be established in China.