再发骨质疏松性椎体骨折的危险因素分析:一项回顾性多中心研究

Risk Factors of Recurrent Osteoporotic Vertebral Fracture:A Retrospective Multicenter Study

目的探讨经皮椎体成形术后,二次发生骨质疏松性椎体压缩性骨折(OVCF)的危险因素。方法共收纳了来自4家医院的432例椎体压缩性骨折患者。记录并分析患者的性别、年龄、BMI、吸烟和饮酒习惯、T评分、25(OH)D、Ⅰ型胶原氨基端延长肽(PINP)和β-CTX血清浓度。对初发的多椎体骨折和连续使用唑来膦酸治疗情况也进行了评估。结果低骨密度和高浓度的血清β-CTX是再发骨折的重要危险因素。初发时即为多椎体骨折的患者,其再次发生骨折的危险性也更高。患者性别、年龄、BMI、PINP水平等因素的变化对再发骨折率无显著影响。连续2年以上的唑来膦酸的治疗,是预防新发OVCF的保护因素。基于上述发现,构建了再发椎体骨折的预测模型,可以更好地评估患者发生该疾病的风险,预防其发生。结论骨密度低、β-CTX水平高、未连续使用二膦酸盐和初发的多个椎体骨折的患者更容易再次发生OVCF。

Objective To investigate the risk factors of recurrent osteoporotic vertebral compression fracture(OVCF)after percutaneous kyphoplasty.Methods A total of 432 vertebral fracture patients from 4 different hospitals were recruited in this study.Patients'gender,age,BMI,smoking,alcohol consumption,T-score,25(OH)D,procollagen typeⅠN-Terminal propeptide(PINP),andβ-CTX serum concentration were recorded and analyzed.Initial multiple vertebral fractures and continuous Zoledronic acid treatment were also evaluated.Results Low bone mineral density and highβ-CTX serum concentration were both significant predictors of re-fracture.Initial multiple vertebral fracture was also in high risk of re-fracture.Variations of patients'gender,age,BMI,PINP level and other factors had no significant effects on the re-fracture rate.Zoledronic acid treatment for more than 2 years was a protective factor to prevent new OVCF.Above all,A predictive model for recurrent vertebral fractures based on the above risk factors was constructed,which could better help clinicians to predict the probability and prevent the occurrence of OVCF.Conclusion Patients with low BMD,highβ-CTX level,absence of bisphosphate application and initial multiple vertebral fractures were more susceptible to a recurrent OVCF.