腰椎退行性疾病患者骨质疏松诊疗情况

Diagnosis and treatment of osteoporosis in patients with lumbar degenerative diseases

目的对腰椎退行性疾病患者的术前骨密度、骨代谢指标状况和骨质疏松治疗情况进行回顾性分析。方法对516例年龄≥50岁的腰椎退行性疾病患者的术前骨密度、骨代谢指标(包括骨转换标志物、血清25OHD)检测情况及骨质疏松治疗情况进行记录,对进行骨密度测定的患者,分析骨密度和年龄的关系;对同时进行骨代谢指标检测和骨密度测定的患者,分析骨密度和骨代谢指标的关系。结果在516例患者中,进行骨密度检测共139人(26.93%),其中检测出骨质疏松65人(46.76%),骨量减少60人(43.17%);骨密度和年龄呈显著负相关(P<0.05)。共有109例(21.12%)患者进行了骨代谢指标检测,具体结果为血清25OHD充足的39例(35.78%),不足的48例(44.04%),缺乏的22例(20.18%)。男性患者血清25OHD和骨密度呈负相关(r=0.467,P=0.021),女性患者血清25OHD和骨密度的相关性无统计学意义。骨转换标志物(β-CTX和P1NP)和骨密度的相关性无统计学意义。在65例被诊断为骨质疏松症的患者中,无任何药物治疗的有14例(21.54%),单纯补充钙剂和(或)普通维生素D的基础治疗有12例(18.46%),抗骨质疏松治疗的39例(60%)。结论腰椎退行性疾病患者术前进行骨质疏松评估较少,骨质疏松症发生率高、诊断率低、治疗率低,应重视对腰椎退行性疾病患者的术前骨密度和骨代谢指标的检测,并积极进行抗骨质疏松治疗。

Objective To retrospectively analyze the preoperative bone mineral density,bone metabolism index status,and osteoporosis treatment in patients with lumbar degenerative diseases.Methods The preoperative bone mineral density,bone metabolism index(including bone turnover markers,serum 25OHD)detection status and osteoporosis treatment status of 516 patients with lumbar degenerative disease aged≥50 years old were recorded,and the bone mineral density was measured,Analyzed the relationship between bone density and age;for patients who perform bone metabolism index detection and bone density measurement at the same time,analyzed the relationship between bone density and bone metabolism index.Results Among 516 patients,a total of 139(26.93%)bone mineral density tests were performed,Among them,65(46.76%)had osteoporosis and 60(43.17%)had bone loss.There was a significant negative correlation between bone density and age(P<0.05).A total of 109(21.12%)patients were tested for bone metabolism indicators.The specific result were 39 patients(35.78%)with sufficient serum 25OHD,48 patients with insufficient serum 25OHD(44.04%),and 22 patients with deficiency(20.18%).There was a negative correlation between serum 25OHD and bone mineral density in male patients(r=0.467,P=0.021),while the correlation between serum 25OHD and bone mineral density in female patients was not statistically significant.The correlation between bone turnover markers(β-CTX and P1NP)and bone mineral density was not statistically significant.Among 65 patients who were diagnosed with osteoporosis,14 patients(21.54%)were not treated with any medication,and 12 patients(18.46%)were treated with basic calcium supplements and/or ordinary vitamin D,39 cases(60%)were treated for osteoporosis.Conclusion Patients with degenerative diseases of the lumbar spine have less osteoporosis evaluation before operation,The incidence of osteoporosis is high,the diagnosis rate is low,and the treatment rate is low.The author believes that atention should be paid to the detection of preoperative bone mineral density and bone metabolism in patients with lumbar degenerative diseases,and anti-osteoporosis treatment should be actively carried out.