中老年人维生素D、骨密度水平与髋部脆性骨折的相关性研究

Correlation between vitamin D,BMD and fragility fracture of hip in middle-aged and elderly people

目的探讨中老年人维生素D(VitD)、骨密度(bone mineral density,BMD)水平与髋部脆性骨折的相关性。方法选取2019年1月至2020年8月在岳阳市人民医院接受治疗的50岁以上患者830例,骨折患者135例(骨折组),非骨折患者695例(非骨折组)。采集所有研究对象的血清,用电化学发光法测定血清25(OH)D水平,应用双能X线吸收仪测定其腰椎及髋部BMD,并在测定骨密度的同时测量患者身高、体重,计算体质量指数(body mass index,BMI),观察骨折组与非骨折组之间的VitD与BMD差异。结果①所有研究对象中25(OH)D严重缺乏者占16.1%、缺乏者占34.7%、轻度缺乏者占29.8%、充足者占19.4%,男性VitD水平高于女性(P<0.001)。而不同年龄和BMI的VitD水平无统计学差异(P=0.878、0.346);②所有研究对象的腰椎、股骨颈BMD(T值)平均为-2.64±1.56及-1.43±1.24,不同性别、年龄、体质量指数研究对象的腰椎及股骨颈BMD水平差异有统计学意义(P<0.001);③髋部骨折组平均VitD为(20.26±10.76)ng/mL,非骨折组为(21.18±10.65)ng/mL,两组间无显著差异(P=0.304);④髋部骨折组腰椎、股骨颈T值低于非骨折组(P<0.001)。对骨折影响因素行单因素分析表明VitD、腰椎T值和股骨颈T值、年龄、体质量指数是髋部脆性骨折的危险因素(P<0.05)。多因素分析表明年龄、体质量指数、股骨颈T值是髋部骨折的独立危险因素(P<0.05),而VitD与腰椎T值对骨折的影响呈现一定的风险增大趋势,但无统计学意义。结论岳阳地区50岁以上人群存在较低的BMD及VitD水平。年龄、体重、体质量指数、股骨颈BMD是中老年人髋部骨折的独立危险因素,VitD不是髋部骨折的独立危险因素。

Objective To investigate the Correlation between Vitamin D(VitD),Bone Mineral Density(BMD)and fragility fracture of hip in middle-aged and elderly people.Methods A total of 830 patients over 50 years old who received treatment in Yueyang People’s Hospital from January 2019 to August 2020 were selected,including 135 fracture patients and 695 non-fracture patients.The serum of all subjects was collected,the serum levels of 25-hydroxyvitamin D[25(OH)D]were measured by electrochemiluminescence immunoassay.Their BMD of lumbar vertebrae and hip were measured by dual-energy X-ray absorptiometry.Height,weight and body mass index(BMI)were measured at the same time as BMD,and VitD and BMD differences between fracture group and non-fracture group were observed.Results①Among the all participators,the prevalence of Vitamin D severe deficiency,deficiency,insufficiency and sufficiency accouted for 16.1%,34.7%,29.8%and 19.4%respectively.The 25(OH)D levels in male participators were significantly higher than female(P<0.001),and there was no statistically significant difference in level of VitD in different age and body mass index(BMI)groups(P=0.878,0.346);②The average values of BMD of lumbar spine and neck of femur were-2.64±1.56 and-1.43±1.24 respectively.There were statistically significant difference in the values of BMD of lumbar spine and neck of femur in different sex,age and BMI groups(P<0.001);③The average 25(OH)D levels was 20.26±10.76 ng/mL in hip fracture group,and 21.18±10.65 ng/mL in non-fracture group.The difference of 25(OH)D levels between hip fracture group and non-fracture group was no statistically significant(P=0.304);④The average values of BMD of lumbar spine and neck of femur were-3.28±1.52 and-2.08±0.99 respectively in hip fracture group,and-2.52±1.54,-1.31±1.24 respectively in non-fracture group.The difference of the values of BMD of lumbar spine and neck of femur between hip fracture group and non-fracture group was statistically significant(P<0.001).The single factor analysis showed that VitD levels,the values of BMD of lumbar spine and neck of femur,age and BMI were the risk factors of hip fracture(P<0.05).Further,the multiple-factors analysis showed that age,BMI and the values of BMD of neck of femur were the independent risk factors of hip fracture.The values of BMD of lumbar spine and VitD levels showed a certain trend of increased risk,but there was no statistical significance.Conclusion The levels of VitD and the values of BMD are quite low in population above 50 in Yueyang.Age,BMI and the values of BMD of neck of femur were the independent risk factors of hip fracture,and VitD levels were not the independent risk factors of hip fracture.