中老年人骨肌减少症与跌倒 骨折风险营养不良指标的相关性

Association of osteosarcopenia with fall,risk of fracture,malnutrition

目的探讨广州社区中老年人骨肌减少症(OS)与跌倒、骨折风险、营养不良指标的相关性。方法选取2017年12月至2019年12月在广州社区居住中老年人(40~90岁)253例进行横断面研究,通过双能X线吸收法检测骨密度、生物阻抗法分析身体成分、握力,步态速度测定,以及在线的骨折风险预测工具FRAX计算患者10年主要部位骨质疏松性骨折和髋部骨折风险。结果依据亚洲肌少症工作组(AWGS)和欧洲肌少症工作组(EWCSOP2)诊断标准定义的OS发生率分别为5.1%~7.6%,5.1%~11.4%。校正年龄和性别后,Logistic回归分析显示:OS与跌倒、骨折风险、营养不良指标具有相关性。应用AWGS标准诊断的OS与跌倒(OR=3.27~5.68,P<0.05),非严重有肌肉减少症(SP)标准诊断的OS与髋部骨折风险(OR=1.14~1.15,P<0.05),去脂体重指数(FFMI)与不同定义的OS呈强相关(OR=0.21~0.48,P<0.05)。结论广州社区中老年人中OS患者的跌倒、骨折与营养不良风险更高,FFMI是OS的独立性危险因素。

Objective To investigate the association of osteosarcopenia with falls,risk of fracture,malnutrition among middle-aged and elderly adults.Methods A total of 253 participants dwelling in Guangzhou community aged 40-90 years were included in this cross-sectional study from December 2017 to December 2019.Bone mineral density(BMD)was detected by dual-energy X-ray absorptiometry(DEXA).Body composition was analyzed by a bioelectrical impedance analysis.Handgrip strength and gait speed were examined.The 10-year probability of a major osteoporotic fracture and hip fracture were evaluated by online WHO fracture risk assessment tool(FRAX®).Results According to diagnostic criteria of AWGS and EWGSOP2,the incidences of osteosarcopenia varied from 5.1%to 7.6%,5.1%to 11.4%respectively.After the adjustment for age and gender,Logistic regression analysis showed that osteosarcopenia was correlated with falls,risk of fracture and malnutrition.Osteosarcopenia definited by AWGS criteria was strongly correlated with falls(OR=3.27-5.68,P<0.05),osteosarcopenia definited by non-severe sarcopenia criteria was strongly correlated with the risk of hip fracture(OR=1.14-1.15,P<0.05),and fat-free mass index was strongly correlated with osteosarcopenia with different definitions(OR=0.21-0.48,P<0.05).Conclusions Osteosarcopenia is associated with higher risk of falls,fracture and malnutrition in the Guangzhou community-dwelling middle-aged and elderly adults,and fat-free mass index is an independent risk factor for osteosarcopenia.