肌少-骨质疏松症增加绝经后妇女桡骨远端骨折风险的病例对照研究

A case controlled study of osteosarcopenia increases distal radius fracture risk in the postmenopausal women

目的确定肌少-骨质疏松症与绝经后妇女桡骨远端骨折的关系。方法选择2018年1月至2019年1月沈阳医学院附属中心医院经X线检查诊断为桡骨远端骨折的绝经后妇女55例(研究组)和按年龄匹配无桡骨远端骨折的绝经后妇女55例(对照组),采用亚洲肌少症工作组推荐意见测定握力及步行速度;应用全身双能X射线吸收测定法测量两组髋部及腰椎骨密度(BMD)、体质量指数(BMI)、相对骨骼肌指数(RSMI)和静止代谢率(RMR),并进行比较。结果研究组中32例诊断为骨质疏松症,21例出现肌少症,15例为肌少-骨质疏松症,而对照组中26例诊断为骨质疏松症,12例出现肌少症,9例为肌少-骨质疏松症;研究组肌少症、肌少-骨质疏松症发生率高于对照组[38.2%(22/55)比21.8%(12/55)、27.3%(15/55)比16.4%(9/55)],差异有统计学意义(P<0.01)。与对照组比较,研究组握力明显降低[(17.4±4.7)kg比(19.2±6.1)kg](P<0.01)。然而,两组步行速度比较差异无统计学意义(P>0.05)。研究组RMR、RSMI、股骨颈和全髋BMD明显低于对照组[(1.02±0.45)kcal/d比(1.38±0.39)kcal/d、(5.21±1.10)kg/m^2比(6.12±1.20)kg/m^2、(0.85±0.25)g/cm^2比(1.12±0.32)g/cm^2、(0.87±0.16)g/cm^2比(1.08±0.43)g/cm^2](P<0.01)。两组腰椎BMD比较差异无统计学意义(P>0.05)。结论骨折的预防和骨折后的处理均应包括评估和治疗肌肉和骨骼两个部分,临床意义在于增加肌肉质量高于老年人的临界值,这可能有助于降低桡骨远端骨折的风险。

Objective To determine the relationship between osteosarcopenia and distal radius fracture in postmenopausal women.Methods Fifty-five cases who diagnosed as distal radius fracture by X-ray in the Affiliated Hospital of Shenyang Medical College from January 2018 to January 2019 was as study group,and 55 cases matched by age for postmenopausal women without distal radius fracture was as control group.Grip strength and gait speed were measured with the recommendation of Asian Sarcopenia Working Group,hip and lumbar bone mineral density(BMD),body mass index(BMI),relative skeletal muscle index(RSMI)and resting metabolic rate(RMR)were measured and compared by dual energy X-ray(DXA),and compared between two groups.Results In study group,32 cases of osteoporosis,21 cases of sarcopenia,15 cases of osteosarcopenia;while 26 cases of osteoporosis,12 cases of sarcopenia and 9 cases of osteosarcopenia in control group.The rate of sarcopenia and osteosarcopenia in study group were significantly higher than those in control group:38.2%(22/55)vs.21.8%(12/55),27.3%(15/55)vs.16.4%(9/55),P<0.01.Compared with the control group,grip strength of study group was decreased significantly:(17.4±4.7)kg vs.(19.2±6.1)kg,P<0.01.However,there was no significant difference in gait speed between the two groups(P>0.05).The RMR,RSMI,BMD of femoral and total hip in study group were significantly lower than those in control group:(1.02±0.45)kcal/d vs.(1.38±0.39)kcal/d,(5.21±1.10)kg/m^2 vs.(6.12±1.20)kg/m^2,(0.85±0.25)g/cm^2 vs.(1.12±0.32)g/cm^2,(0.87±0.16)g/cm^2 vs.(1.08±0.43)g/cm^2,P<0.01.However,there was no significant difference in lumbar BMD between the two groups(P>0.05).Conclusions Fracture prevention and post-fracture management should include evaluation and treatment of muscles and bones.The clinical significance is that increasing the muscle mass above the critical value of the elderly may help to reduce the risk of distal radius fracture.