老年骨质疏松性髋部骨折患者骨密度与铁代谢关联性的性别分层研究

Gender stratification study on association of bone mineral density with iron metabolism in elderly patients with osteoporotic hip fractures

目的分析老年骨质疏松性髋部骨折患者骨密度与铁代谢关联性,并行性别分层研究。方法回顾性分析156例老年骨质疏松性髋部骨折患者临床资料(观察组),并纳入同期入院体检的156例未骨折老年骨质疏松者作为对照组,比较两组血清铁蛋白(Fer)、钙(Ca)、镁(Mg)、磷(P)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、Ⅰ型原胶原氨基末端前肽(PINP)、25-羟基维生素D(25OHD)、骨密度等基线资料,分析老年骨质疏松性髋部骨折的危险因素;并分析血清学指标、骨密度在不同性别老年骨质疏松性髋部骨折患者中的差异及相关性。结果两组性别、大量饮酒史、吸烟史、体质指数及血清Ca、Mg、P比较,差异均无统计学意义(P>0.05);观察组年龄≥75岁、Fer>150 ng/mL、β-CTX>650 pg/mL、PINP>55 pg/mL、25OHD<20.0 ng/mL、股骨颈T值<-3.5 SD占比均高于对照组(P<0.05)。条件logistic回归分析显示,年龄≥75岁、Fer>150 ng/mL、25OHD<20.0 ng/mL、股骨颈T值<-3.5 SD均为老年骨质疏松性髋部骨折的危险因素(OR=3.374、4.255、2.699、6.366,P<0.05)。老年骨质疏松性髋部骨折患者中,女性血清Fer、β-CTX、PINP均高于男性(P<0.05),血清25OHD及股骨颈T值则低于男性(P<0.05)。Pearson相关性分析显示,女性患者股骨颈T值与血清Fer、β-CTX、PINP均呈负相关(r=-0.752、-0.556、-0.493,P<0.05),与血清25OHD呈正相关(r=0.443,P<0.05);男性患者股骨颈T值与血清β-CTX、PINP呈负相关(r=-0.693、-0.521,P<0.05),与血清25OHD呈正相关(r=0.409,P<0.05),但与血清Fer并无相关性(r=0.113,P>0.05)。结论维生素D缺乏、骨密度下降是导致老年骨质疏松性髋部骨折的重要因素,血清Fer增多与绝经后女性骨质疏松性髋部骨折风险有关。

Objective To analyze the association between bone mineral density and iron metabolism in elderly patients with osteoporotic hip fractures,and to perform the gender stratification study.Methods The clinical data of 156 elderly patients with osteoporotic hip fracture were retrospectively analyzed(observation group),and another 156 elderly patients with osteoporosis but without fracture who were matched by gender and age were included as control group.The baseline data such as serum ferritin(Fer),calcium(Ca),magnesium(Mg),phosphorus(P),βcross-linked C-telopeptide of type I collagen(β-CTX),N-terminal propeptide of Type I precollagen(PINP),25-hydroxyvitamin D(25OHD)and bone mineral density were compared between the two groups,and the risk factors of elderly osteoporotic hip fractures were analyzed.The differences and correlations of serological indicators and bone mineral density in elderly patients with osteoporotic hip fractures of different genders were analyzed.Results There were no statistical differences in gender,age,history of heavy drinking,smoking history,body mass index,and serum Ca,Mg and P between the two groups(P>0.05).The proportions of age≥75 years old,Fer>150 ng/mL,β-CTX>650 pg/mL,PINP>55 pg/mL,250HD<20.0 ng/mL and femoral neck T value<-3.5 SD were significantly higher in observation group than those in control group(P<0.05).Conditional logistic regression analysis showed that age≥75 years old,Fer>150 ng/mL,250HD<20.0 ng/mL,and femoral neck T value<-3.5 SD were all risk factors for elderly osteoporotic hip fractures(OR=3.374,4.255,2.699 and 6.366,respectively,P<0.05).Among elderly patients with osteoporotic hip fractures,serum levels of Fer,β-CTX and PINP in females were significantly higher than those in males(P<0.05),while serum 250HD and femoral neck T value were significantly lower than those in males(P<0.05).Pearson correlation analysis showed that the femoral neck T value of female patients was negatively correlated with serum Fer,β-CTX and PINP(r=-0.752,-0.556,-0.493,P<0.05);and was positively correlated with serum 250HD(r=0.443,P<0.05).Femoral neck T value of male patients was negatively correlated with serumβ-CTX and PINP(r=-0.693,-0.521,P<0.05);and was positively correlated with serum 250HD(r=0.409,P<0.05),but was not correlated with serum Fer(r=0.113,P>0.05).Conclusion Vitamin D deficiency and decreased bone mineral density are important factors leading to osteoporotic hip fractures in the elderly,and the increase of serum Fer is correlated to the risk of osteoporotic hip fractures in postmenopausal women.