不同慢性病中老年女性骨折风险及低骨量切点预测分析

Fracture risk analysis and prediction of low bone mass tangential points in middle-aged and elderly women with different chronic diseases

背景:中老年女性是骨质疏松的高发人群,慢性病增加骨质疏松罹患风险。低骨量是骨质疏松发病前的危险阶段,目前缺少常见慢性病人群的骨折风险差异及诊断指标切点值的相关报道。目的:通过对不同慢性病中老年女性骨折风险的分析,探讨肥胖、高血压、高血脂、糖尿病、动脉硬化与骨密度的相关性,找到可预测低骨量指标的切点值,为防治骨质疏松提供参考。方法:将45-70岁203名女性受试者分为正常组和慢性病组,采用超声骨密度测量仪进行跟骨骨密度测试,采用动脉硬化仪测试肱-踝脉搏波传导速度,采用全自动生化分析仪测试血糖、血脂,采用身体成分分析仪测试体质量指数、脂肪质量及肌肉质量。结果与结论:①61-70岁女性骨密度和骨折风险系数及51-60岁、61-70岁骨强度与<50岁比较,差异有显著性意义(P<0.05);②糖尿病组骨折风险明显高于其余各组,动脉硬化组则高于正常组和肥胖组(P<0.05);③骨密度与年龄、左侧血管弹性程度、右侧血管弹性程度、三酰甘油呈负相关,与体质量指数呈正相关(P<0.05);上述指标与骨密度受试者工作特征(ROC)曲线下面积介于0.5-0.7之间,低骨量对应切点分别为55.5岁(年龄)、756.0 cm/s(左侧血管弹性)、789.0 cm/s(右侧血管弹性)、1.115 mmol/L(三酰甘油)、22.35 kg/m^(2)(体质量指数);④结论:糖尿病和动脉硬化增加中老年女性骨折风险,测定体质量指数、血管弹性和三酰甘油对女性低骨量预测具有一定早期诊断价值。

BACKGROUND:Middle-aged and elderly women have a high risk of osteoporosis,and chronic diseases increase the risk of osteoporosis.Low bone mass is a risk stage before the onset of osteoporosis.There are a small amount of relevant reports on the difference of fracture risk and the tangent value of diagnostic indicators in the population with common chronic diseases.OBJECTIVE:Through the analysis of fracture risk of middle-aged and elderly women with different chronic diseases,to investigate the correlation between obesity,hypertension,hyperlipemia,diabetes,arteriosclerosis and bone mineral density and identify the cut-off value of low bone mass index,thereby providing reference for the prevention and treatment of osteoporosis.METHODS:A total of 203 cases of female adults aged 45-70 years were divided into normal group and chronic disease group.The calcaneal bone density was measured by using an ultrasonic bone densitometer.Brachial-ankle pulse wave velocity was tested by using an arteriosclerotic instrument.Blood sugar and blood lipid were tested by using an automatic biochemical analyzer.Body mass index,fat mass and muscle mass were measured by using a body composition analyzer.RESULTS AND CONCLUSION:There were significant differences in body mass index and fracture risk coefficient of women aged 61-70 years and bone strength of women aged 51-60 years and 61-70 years compared with those aged<50 years(P<0.05).The fracture risk of diabetes group was significantly higher than that of the other groups,while the fracture risk of arteriosclerosis group was significantly higher than that of normal group and obesity group(P<0.05).Bone mineral density was negatively correlated with age,left vascular elasticity,right vascular elasticity and triglyceride level,but positively correlated with body mass index(P<0.05).The area under the receiver operating characteristic curve of body mass density and the above indexes was 0.5-0.7,and the corresponding tangents of low body mass density were 55.5 years old(age),756.0 cm/s(left vascular elasticity),789.0 cm/s(right vascular elasticity),1.115 mmol/L(triglyceride level)and 22.35 kg/m^(2)(body mass index).To conclude,diabetes and arteriosclerosis increase the risk of fracture in middle-aged and elderly women.Body mass index,vascular elasticity and triglyceride level have a certain early diagnostic value in predicting low bone mass in women.