绝经后妇女骨密度、骨面积与椎体骨折的相关性分析

Analysis between bone mineral density,bone area and vertebral fracture in post-menopausal women

目的探讨骨密度(bone mineral density,BMD)、骨面积与绝经后妇女椎体骨折发生的相关性。方法回顾分析980例绝经后妇女临床病例资料,486例(46~98岁)有椎体压缩性骨折为骨折组,494例(49~94岁)无椎体压缩性骨折为对照组。两组均记录双能X线吸收测量仪(dual energy X-ray absorptiometry,DXA)检测的腰椎和股骨近端BMD、骨面积数据;使用Logistic回归模型分析椎体骨折发生、椎体骨折数目与各临床因素间关系;不同部位BMD及骨面积预测骨折的精确性采用受试者工作特征(receiver operating characteristic,ROC)曲线分析,使用χ2检验比较两组间骨质疏松症检出率。结果椎体骨折组,身高、体质量、体质量指数(body mass index,BMI)及绝经年龄均显著低于对照组(P<0.05),且腰椎BMD、腰椎面积及近端股骨BMD显著低于对照组(P<0.001)。腰椎BMD与是否发生椎体骨折及椎体骨折数关联性最高,其次为股骨大转子BMD。校正BMI后,腰椎BMD每下降1个标准差,发生椎体骨折与椎体骨折数增加的RR分别为2.76(95%CI:2.22~3.42)和2.59(95%CI:2.15~3.13);股骨大转子BMD每下降1个标准差,发生椎体骨折与椎体骨折数增加的RR分别为1.62(95%CI:1.30~2.01)和1.81(95%CI:1.50~2.19)。不同部位BMD预测骨折的准确性为0.682~0.776,而不同部位骨面积预测骨折的准确性为0.455~0.596。根据腰椎、全髋部、股骨颈以及股骨大转子的BMD,骨折组骨质疏松症的诊断率分别为46.2%、39.9%、40.7%和31.1%。结论腰椎和股骨大转子部位BMD是绝经后妇女椎体骨折最重要的预测因素,腰椎及股骨近端面积预测椎体骨折的作用较小。

Objective To investigate the correlation between bone mineral density(BMD),bone area,and the occurrence of vertebral fractures in post-menopausal women.Methods The clinical data of 980 post-menopausal women were retrospectively analyzed.486 cases(46-98 years old)with vertebral compression fractures were taken as the fracture group,and 494 cases(49-94 years old)without vertebral compression fractures were taken as the control group.Data on bone mineral density and bone area of lumbar vertebrae and proximal femur detected by dual energy X-ray absorptiometry(DXA)were recorded in both groups.Logistic regression models was performed to analyze the correlation between the occurrence of vertebral fractures,the number of vertebral fractures,and various clinical factors.The accuracy of predicting fractures with different parts of BMD and bone area was analyzed using receiver operating characteristic curve(ROC).Comparing the detection rate of osteoporosis was completed between two groups through chi square test.Results The height,weight,body mass index(BMI),and menopausal age of the fracture group were significantly lower than those of the control group(P<0.05).BMD,bone area of lumbar vertebrae and BMD of proximal femur in the fracture group were also significantly lower compared with control group(P<0.001).Lumbar BMD had the highest correlation with the occurrence of vertebral fracture and the number of vertebral fractures,followed by femoral greater trochanter BMD.On the basis of adjusting BMI,for each 1 standard deviation(SD)decrease in lumbar BMD,the relative risk(RR)for the occurrence of vertebral fractures and the increase in the number of vertebral fractures were 2.76(95%CI:2.22-3.42)and 2.59(95%CI:2.15-3.13),respectively.While for each SD decrease in greater trochanter BMD,RR of vertebral fracture and increase in the number of vertebral fractures was 1.62(95%CI:1.30-2.01)and 1.81(95%CI:1.50-2.19),respectively.The accuracy of BMD and bone area in each site to predict fractures ranged from 0.682 to 0.776 and 0.455 to 0.596,respectively.According to the BMD of lumbar vertebrae,total hip,femoral neck,and greater trochanter,the diagnostic rates of osteoporosis in fracture group were 46.2%,39.9%,40.7%,and 31.1%,respectively.Conclusions Our study suggests that selecting BMD at the lumbar vertebrae and greater trochanter for predicting vertebral fractures in post-menopausal women has statistical significance.Bone area has no statistical significance on predicting vertebral fracture.