慢性疾病稳定期老年患者发生骨质疏松症的影响因素研究

Associated Factors of Osteoporosis in Elderly Patients with Stable Chronic Conditions

背景随着我国人口老龄化程度的加剧,骨质疏松症患病率逐年升高。当前关于骨质疏松症的具体病因和发病机制尚未十分明确,其预防和治疗工作尚存短板。目的调查慢性疾病稳定期老年患者骨质疏松症患病率,并分析发生骨质疏松症的影响因素。方法选取2020年11月至2021年9月在云南省第一人民医院老年医学科住院复查的慢性疾病稳定期老年患者302例为研究对象。利用双能X线吸收测定法(DXA)对患者腰椎及髋部骨密度进行测定,以T值≤-2.5为骨质疏松症。收集患者一般资料,采用自主研发的“老年综合评估系统软件平台”对患者进行老年综合评估,并抽取患者空腹静脉血,检测血清生物学标志物。结果302例患者中非骨质疏松症176例(58.3%)、骨质疏松症126例(41.7%)。多因素Logistic回归分析结果显示,失眠〔OR=2.180,95%CI(1.080,4.443)〕、合并慢性疾病数量多〔OR=1.223,95%CI(1.101,1.358)〕、同型半胱氨酸水平升高〔OR=1.043,95%CI(1.000,1.088)〕是慢性疾病稳定期老年患者发生骨质疏松症的危险因素(P<0.05),血尿酸水平升高〔OR=0.996,95%CI(0.993,0.999)〕是慢性疾病稳定期老年患者发生骨质疏松症的保护因素(P<0.05)。结论慢性疾病稳定期老年患者骨质疏松症患病率为41.7%。血尿酸水平升高是慢性疾病稳定期老年患者发生骨质疏松症的保护因素,失眠合并慢性疾病数量多、同型半胱氨酸水平升高是慢性疾病稳定期老年患者发生骨质疏松症的危险因素。

Background China is seeing increasingly osteoporosis prevalence as ageing marches on.However,the specific etiology and pathogenesis of osteoporosis are still unclear,and there are still limitations in its prevention and treatment.Objective To investigate osteoporosis prevalence and associated factors in older Chinese patients with stable chronic conditions.Methods Three hundred and two elderly inpatients with stable chronic conditions who underwent a reexamination in Department of Geriatrics,Yunnan First People’s Hospital from November 2020 to September 2021 were recruited.Dual-energy X-ray absorptiometry(DXA)was used to measure lumbar spine and hip bone mineral density(BMD).T value≤-2.5 was defined as osteoporosis.Demographic data were collected.Comprehensive geriatric assessment was conducted via a self-developed online platform named Comprehensive Geriatric Assessment.Fasting venous blood samples were collected and measured for serum biomarkers.Results Among the patients,126(41.7%)were found with osteoporosis,and other 176(58.3%)without.Binary Logistic regression analysis indicated that insomnia〔OR=2.180,95%CI(1.080,4.443)〕,multiple chronic conditions〔OR=1.223,95%CI(1.101,1.358)〕,elevated homocysteine〔OR=1.043,95%CI(1.000,1.088)〕were associated with increased risk of osteoporosis(P<0.05),while elevated serum uric acid level〔OR=0.996,95%CI(0.993,0.999)〕was associated with decreased risk of osteoporosis(P<0.05).Conclusion The prevalence of osteoporosis in these older patients with stable chronic conditions was 41.7%.The probability of osteoporosis may be decreased with elevated serum uric acid level,and increased with elevated homocysteine,insomnia and multiple chronic conditions.