不同性别老年髋部骨折患者骨密度T值及骨代谢状况分析

Analysis of bone mineral density and bone metabolism in elderly hip fracture patients of different genders

目的了解不同性别老年髋部骨折患者的骨密度情况及骨折早期骨转换生化标志物的变化特点及差异。方法收集2015年5月至2017年12月北京积水潭医院老年髋部骨折病房住院的1161例患者临床资料、骨密度检查结果以及血清I型前胶原氨基末端前肽(P1NP)、25羟基维生素D3[25-(OH)VD3]、I型胶原交联羧基末端肽β降解产物(β-CTX)、血清骨钙素(OC)、甲状旁腺激素(PTH)等进行回顾性研究。结果共纳入女831例,男330例,其中(1)腰椎及髋部总体骨密度显示:T≥-1.0 SD分别为30.4%(353/1161)、6.8%(79/1161);-2.5 SD<T<-1.0 SD分别为36.6%(425/1161)、44.7%(519/1161);T≤-2.5 SD分别为33.0%(383/1161)、48.5%(563/1161)。其中髋部骨密度T值敏感性优于腰椎,女骨密度值低于男,与增龄明显相关的骨密度值,男为股骨颈、总髋T值(股骨颈优于总髋),女为髋部各项骨密度值其中以总髋T值相关性最强(均P<0.05);(2)老年髋部骨折早期25-(OH)VD3水平明显低于正常,骨吸收及骨形成指标总体未见明显升高;女性tP1NP、β-CTX、OC、PTH水平均高于男性,25-(OH)VD3水平低于男性(均P<0.05);随骨密度T值降低,β-CTX、OC升高,25-(OH)VD3则降低(均P<0.05)。结论随着年龄增长,男、女老年髋部骨折患者骨密度T值均呈下降趋势,但女性下降更快、更早。总体骨密度T值诊断老年骨质疏松或预测老年髋部骨折不够敏感,尤其对男性敏感性更差。骨折早期患者骨转换代谢标志物存在不同程度变化,总体呈现骨吸收与骨形成双向减低的特点,OC、β-CTX及VD水平提示早期骨代谢异常方面的作用需要关注。

Objective To understand changes and characteristics of bone mineral density(BMD)and early-stage bone turnover biochemical markers in elderly hip fracture patients of different genders.Methods This was a retrospective cohort study.A total of 1161 elderly patients with hip fractures hospitalized in Beijing Jishuitan Hospital from May 2015 to December 2017 were enrolled.Based on gender,patients were divided into the female group(n=831)and the male group(n=330).Clinical data,BMD,serum type I procollagen amino terminal propeptide(P1NP),and 25-hydroxyvitamin D3[25-(OH)VD3],type I collagen cross-linked carboxy terminal peptide beta degradation products(β-CTX),osteocalcin(OC)and parathyroid hormone(PTH)were measured and compared between the two groups.Results Of the 1161 elderly patients with hip fractures,831 were female and 330 were male.The BMD of the lumbar vertebrae and the total hip in the female and male groups showed that 30.4%(353/1161)and 6.8%(79/1161)had T≥-1.0 SD respectively;36.6%(425/1161)and 44.7%(519/1161)had-2.5 SD<T<-1.0 SD;and 33.0%(383/1161)and 48.5%(563/1161)had T≤-2.5 SD respectively.The sensitivity of the hip BMD T value was better than that of lumbar vertebrae(P<0.05).Female BMD was significantly lower than that of male BMD(P<0.05).The BMD T values,which were significantly related to age,were recorded at the femoral neck and the total hip(femoral neck was better than total hip)for males and at total hip(the total hip T value is the most strongly related index)for females;(2)In the early stage of elderly hip fractures,25-(OH)VD3 was significantly lower than normal,and bone resorption and bone formation indexes were not significantly increased(P>0.05).The levels of tP1NP,β-CTX,OC and PTH in females were higher than those in males,and the level of 25-(OH)VD3 was lower than that in males(all P<0.05).As the T value decreased,β-CTX and OC increased and 25-(OH)VD3 decreased accordingly(all P<0.05).Conclusions With the increase of age,the BMD T value in elderly patients with hip fractures shows a downward trend,but its decline in women is faster and earlier.Overall,the BMD T value is not sensitive enough for osteoporosis diagnosis or hip fracture prediction in the elderly,especially in men.In the early stage of fractures,the bone turnover biochemical markers show varying degrees of change,and bone resorption and bone formation are both reduced.The significance of OC,β-CTX and VD levels in early bone metabolic abnormalities requires further study.