骨转换标志物与骨密度预测老年女性骨质疏松性骨折的对比研究

Comparative study of bone turnover markers and bone mineral density in prediction of osteoporotic fractures in the elder women

目的探讨骨密度与骨转换标志物(bone turnover markers,BTMs)在老年女性骨质疏松患者中的检测意义,对比两者对骨质疏松性骨折(osteoporotic fracture,OF)的预测能力。方法收集2017年10月至2019年2月于成都医学院第一附属医院骨科住院的OF患者96例和骨质疏松患者107例,分为骨折组和非骨折组。通过双能X线吸收仪(DXA)测定骨密度,电化学发光检测BTMs:I型前胶原N端前肽(PINP)、I型胶原β-异构化C末端肽(β-CTX)、骨钙素N端分子片段(N-MID),同时测定骨代谢相关指标:碱性磷酸酶(alkaline phosphatase,ALP)、钙(Ca)、磷(P),t检验对比两组间的计量资料,采用二分类Logistic回归分析骨密度和BTMs与OF的相关性。结果骨折组的骨密度低于非骨折组,差异有统计学意义(P<0.05);PINP、β-CTX高于非骨折组,70~90岁患者N-MID低于非骨折组,差异均有统计学意义(P<0.05);而ALP、P、Ca在两组之间相比,差异无统计学意义(P>0.05)。二分类Logistic回归分析提示腰椎及髋部骨密度、β-CTX与OF具有显著相关性,OR分别为-4.182、-6.929和7.572,差异均有统计学意义(P<0.05)。PINP、N-MID与OF呈正相关,OR分别为4.213和2.510,差异均无统计学意义(P>0.05)。结论低骨密度、高β-CTX的骨质疏松老年女性更容易发生OF,β-CTX比骨密度预测OF的能力更强,可适时对高危人群进行相关干预管理。

Objective To investigate the clinical significance of detection of bone mineral density(BMD)and bone turnover markers(BTMs)in the elder women with osteoporosis,and to compare their predictive power of osteoporotic fracture(OF).Methods From October 2017 to February 2019,96 patients with OF and 107 patients with osteoporosis who were hospitalized in the department of orthopedics at the First Affiliated Hospital of Chengdu Medical College were examined.They were divided into fracture group and non-fracture group.BMD was measured using dual-energy X-ray absorptiometry(DXA).BTMs,including type I procollagen amino terminal peptide(PINP),β-cross-linked C-telopeptide of type I collagen(β-CTX),and molecular fragment of osteocalcin N terminal(N-MID)were detected with electrochemiluminescence.Bone metabolism related indicators,including alkaline phosphatase(ALP),calcium(Ca),and phosphorus(P)were detected at the same time.The measurement data between the two groups were compared using independent-samples t test.The correlation between BMD and BTMs and OF was analyzed using binary logistic regression.Results BMD in the fracture group was lower than that in the non-fracture group(P<0.05).PINP andβ-CTX were higher than in the non-fracture group.N-MID was lower than in the non-fracture group in 70-90 years old patient,and the difference was statistically significant(P<0.05).There was no significant difference in ALP,P,and Ca between two groups(P>0.05).Binary logistic regression analysis showed that BMD in the lumbar spine and hip was significantly correlated withβ-CTX and OF(OR=-4.182,-6.929,7.572,respectively),and the differences were statistically significant(P<0.05).PINP and N-MID were positively correlated with OF(OR=4.213,2.510,respectively),but the difference was not statistically significant(P>0.05).Conclusion Osteoporotic elder women with low BMD and highβ-CTX are more likely to develop OF.β-CTX is more capable than BMD to predict OF.It can help timely manage and take related interventions for the high-risk population.