北京地区中老年人FRAX骨折风险评估与BMD、骨代谢相关生化指标间的相关回归研究

Correlation study between the fracture risk assessment of FRAX and BMD, bone metabolism-related biochemical markers in middle-aged and elderly people in Beijing

目的 探讨北京南郊地区中老年人FRAX评估未来10年全身骨折风险PMOF、骨密度BMD、骨代谢相关指标指标25(OH)D3、PTH、N-MID等在年龄、性别、体质指数之间的差异及变化趋势,研究PMOF、骨密度与各骨代谢相关生化指标之间的相关性。 方法 收集接受DXA桡骨远端骨密度(BMD)检查的体检人群1133例,代入FRAX骨折风险评估工具计算全身主要部位骨折概率(PMOF),收集相应骨代谢生化指标:25-羟维生素D3[25(OH)D 3],血清骨钙素N端中分子片段(N-MID),甲状旁腺素(PTH)、血钙(Ca)、血磷(P)、血清碱性磷酸酶(ALP)等。分析比较各指标随年龄的变化趋势,比较各年龄组各指标性别间差异;分析比较不同性别、各年龄组中各指标在不同体质指数之间的差异及其变化趋势;采用多元逐步回归法分别分析未来10年骨折风险概率(PMOF)、BMD与各因素、各生化指标之间的相关回归关系。 结果 非优势手臂桡骨远端1/3处骨密度BMD随年龄增长而降低,各年龄组男性BMD值均大于女性,PMOF随年龄增长而增加,各年龄组男性PMOF均小于女性,差异有统计学意义( P <0.05);各年龄组25(OH)D 3水平男性均大于女性,50岁以上年龄组N-MID男性均小于女性,差异有统计学意义( P <0.05);多元逐步回归分析中BMD与年龄、N-MID呈负相关,与BMI为正相关,男性大于女性;PMOF与BMD、年龄呈负相关,与BMI、N-MID呈正相关,男性小于女性;在不同性别、各年龄组中BMI正常组的PMOF最低,超重组最高,差异有统计学意义。其他生化指标与BMD、PMOF之间的相关关系不显著( P >0.05)。 结论 BMD、PMOF与性别、年龄、BMI、骨钙素均相关,其中女性OF的风险均高于男性;BMD随年龄增长而降低,骨折风险增加;BMD与BMI呈正相关,但PMOF表现为超重人群骨折风险最高,故超重亦是使骨折风险增加的危险因素。随血清骨钙素增高,BMD降低,骨折风险增高,可在一定程度上反映骨组织的新陈代谢情况。关注骨代谢生化指标变化可在一定程度上预判骨密度及PMOF水平,对骨质疏松及其骨折的的早发现、早诊断、早预防和早治疗提供一定参考及理论依据。

Objective To explore the FRAX in the evaluation of 10-year fracture risk in PMOF, in the elderly with different age, sex, body mass index, bone mineral density (BMD), and bone metabolic related index 25(OH)D 3, PTH, and N-MID, in the southern suburb of Beijing, and to study the correlation between PMOF, bone mineral density, and bone metabolism-related biochemical markers. Methods A total of 1083 patients who underwent distal bone mineral density (BMD) examination with DXA were enrolled. The FRAX fracture risk assessment tool was used to calculate the main body fracture probability (PMOF). The corresponding biochemical indicators of bone metabolism were collected, including 25-hydroxyvitamin D 3 [25 (OH)D 3], serum osteocalcin N-terminal molecular fragment (N-MID), parathyroid hormone (PTH), serum calcium (Ca) and phosphorus (P), and serum alkaline phosphatase (ALP). The change trend of each index with age and the gender difference among different age groups were analyzed and compared. Multiple stepwise regression method was used to analyze the relationship between fracture risk probability (PMOF), BMD and various biochemical indicators in the next 10 years. Results BMD of the distal radius of non-dominant arm decreased following aging. The mean BMD was higher in males than in females in each age group. PMOF increased following aging, and it was lower in males than in females in each age group, with significant difference ( P <0.05). The levels of 25 (OH)D 3 were higher in males than in females in each age group. N-MID was lower in males than in females in over 50 years old groups. Multiple stepwise regression analysis showed that BMD was negatively correlated with age and N-MID, but was positively correlated with BMI. PMOF was negatively correlated with BMD and age, but was positively correlated with BMI and N-MID. PMOF was the lowest in the normal BMI groups, but was the highest overweight groups, among different gender and age groups, with significant difference. The correlations between other biochemical indexes and BMD, PMOF were not significant. Conclusion BMD and PMOF are associated with gender, age, BMI, and osteocalcin. The risk of female OF is higher than that of male OF. BMD decreases with aging and the risk of fracture increases. BMD is positively correlated with BMI, but PMOF shows that fracture risk is high in overweight people. Therefore, overweight is a risk factor for fractures. With the increase of serum osteocalcin, BMD is reduced, and the risk of fracture is increased, which reflects the bone metabolism to some extent. Paying attention to the changes of biochemical indicators of bone metabolism can predict BMD and PMOF level to a certain extent, and provide evidence and theoretical basis for early detection, early diagnosis, early prevention, and early treatment of osteoporosis and fractures.