老年女性髋部脆性骨折骨密度特点:病例对照研究

Assessments of bone mineral density for elderly frailty hip fracture women with large sample size:a case-control study

目的应用定量CT(quantitative computed tomography,QCT)Pro软件中的CT X线吸收检测法(CT X-ray absorptiometry,CTXA)髋部分析系统对老年女性髋部骨折患者的髋部CT扫描图像进行分析,测量髋部面积和体积骨密度。方法纳入低能量髋部骨折女性患者447例及老年女性健康志愿者528例(对照组)。所有研究对象均行髋部QCT扫描。CTXA测量股骨近端感兴趣区(region of interest,ROI)包括:全髋(total hip,TH)、股骨颈(femoral neck,FN)、大转子(trochanter,TR)和转子间区(intertro-chanter,IT),并测量相应ROI的面积骨密度(areal BMD,aBMD)(g/cm^(2))和体积骨密度(volumetric BMD,vBMD)(mg/cm3)。结果髋部骨折组和健康对照组平均年龄分别为(74.8±9.2)岁和(68.1±8.8)岁。健康对照组TH aBMD和FN aBMD分别为(0.7±0.1)和(0.6±0.1)g/cm^(2),而髋部骨折组TH aBMD和FN aBMD分别为(0.6±0.1)和(0.5±0.1)g/cm^(2)。髋部骨折组TH aBMD/vBMD、FN aBMD/vBMD、TR aBMD/vBMD及IT aBMD/vBMD均低于正常对照组。股骨近端各ROI的aBMD与身高和体质量均有相关性,但与校正年龄后的身高和体质量无相关;而股骨近端各区域的vBMD与身高无明显相关,与体质量存在弱相关性。结论与老年女性健康志愿者相比,髋部脆性骨折患者股骨近端各区域的aBMD和vBMD均明显降低,但在不同年龄层,骨密度减低的区域不同。vBMD不受身高体质量影响,因而脆性骨折风险预测应用vBMD值得进一步研究。

Objective To assess the bone mineral density(BMD)for elderly frailty hip fracture women using the CT X-ray absorptiometry(CTXA)hip module in quantitative CT(QCT)Pro software.Methods We recruited 447 women with low-energy hip fracture as cases and 528 healthy elderly women as controls.All participants had hip QCT scans.Areal and volumetric bone mineral density(aBMD and vBMD)of the total hip(TH),femoral neck(FN),trochanter(TR),intertrochanter(IT)areas were measured by CTXA.Results The mean age of hip fracture group and control group was(74.8±9.2)years and(68.1±8.8)years,respectively.TH aBMD and FN aBMD values of controls were(0.7±0.1)and(0.6±0.1)g/cm^(2),and those of hip fracture cases were(0.6±0.1)and(0.5±0.1)g/cm^(2).TH aBMD/vBMD,FN aBMD/vBMD,TR aBMD/vBMD and IT aBMD/vBMD of hip fracture cases were all lower than those of controls.All aBMD of the proximal femur were correlated with height and weight,but no significance was observed after adjustment of age.vBMD of all regional of interest(ROIs)had no associations with height but weak associations with weight.Conclusion Compared to the healthy women,women with hip fracture have lower aBMD and vBMD in all regions of the proximal femur according to age stratification.The measurements of vBMD have less correlation with anthropometric factors and might be highlighted as the preferred measurement in hip fracture risk assessments.