生殖因素对绝经后骨质疏松性椎体压缩性骨折的影响

Effects of reproductive factors on osteoporotic vertebral compression fractures in post-menopausal women

目的探讨生殖因素与绝经后女性骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fractures,OVCFs)的关系。方法收集2018年1月至2022年5月在山西白求恩医院住院治疗的绝经后女性骨质疏松性椎体压缩骨折患者(n=210)为骨折组,以骨折组为标准,按年龄配对,收集对照组(n=282)。分析骨折组临床表现、骨折部位,比较两组研究对象的一般资料、生化指标、腰椎骨密度(bone mineral density,BMD)。用双能X线吸收测量仪(dual energy X-ray absorptiometry,DXA)测量腰椎椎体L1-L4 BMD,用受试者工作特征(receiver operating characteristic,ROC)曲线评价腰椎BMD及T值对两组受试者分类效果,得出临界值。采用二分类Logistic回归分析与绝经后女性OVCFs有关的生殖因素。结果骨折组主诉有OVCFs临床表现的患者共141例(占OVCFs总数的67.1%),骨折部位以胸12椎体最多(60例,占OVCFs总数的28.5%),与非OVCFs女性相比,身高、体质量、高密度脂蛋白胆固醇、骨密度差异有统计学意义(P<0.05);DXA测得腰椎骨密度T值评估OVCFs的曲线下面积(area under the curve,AUC)值为0.76,最佳分类界值为-2.215,敏感度为0.762,特异度为0.338。根据腰椎骨密度测定值评估OVCFs的AUC值为0.753,最佳分类界值为0.922,敏感度为0.745,特异度为0.657。二元Logistic回归分析显示:生殖维持年限短(OR=0.387,95%CI:0.212~0.708,P<0.05)、绝经年龄早(OR=0.244,95%CI:0.139~0.428,P<0.05)、哺乳时间短(OR=0.736,95%CI:0.597~0.908,P<0.05)是绝经后女性OVCFs的危险因素。结论哺乳时间和生育年限短,绝经年龄早会促进绝经后女性OVCFs的发生,临床工作中需关注这些危险因素。

Objective To investigate the relationship between reproductive factors and osteoporotic vertebral compression fractures(OVCFs)in post-menopausal women.Methods Post-menopausal female patients with osteoporotic vertebral compression fracture admitted to Shanxi Bethune Hospital from January 2018 to May 2022(n=210)were selected as the fracture group.The fracture group was taken as the standard,and the control group(n=282)matched by age was collected.Clinical manifestations and fracture sites were analyzed in the fracture group.The general data,biochemical indexes,and lumbar bone mineral density(BMD)of the two groups were compared.The L1-L4 BMD of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry(DXA).The classification effects of lumbar BMD in the two groups was evaluated by receiver operating characteristic(ROC)curve,and the critical value of BMD was obtained.Binary Logistic regression was used to analyze the reproductive factors related to OVCFs in post-menopausal women.Results There were 141 patients with clinical manifestations of OVCFs in the fracture group,it accounted for 67.1%of the total OVCFs,and the most common fracture site was thoracic 12 vertebrae(60 cases,accounting for 28.5%of the total OVCFs).Compared with non-OVCFS women,there were statistically significant differences in height,weight,high-density lipoprotein,and bone mineral density(P<0.05).The area under the curve(AUC)value of the lumbar BMD T value measured by DXA in evaluating OVCFs was 0.76,the best classification cut-off value was-2.215,the sensitivity was 0.762,and the specificity was 0.338.The AUC value of OVCFs evaluated by lumbar BMD was 0.753,the best classification boundary value was 0.922,the sensitivity was 0.745,and the specificity was 0.657.Binary Logistic regression analysis showed that short reproductive maintenance years(OR=0.387,95%CI:0.212-0.708,P<0.05),early menopause age(OR=0.244,95%CI:0.139-0.428,P<0.05)and short lactation time(OR=0.736,95%CI:0.597-0.908,P<0.05)were the risk factors of OVCFs in post-menopausal women.Conclusion Short lactation time and childbearing years,and early menopause age are the risk factors of OVCFs in post-menopausal women.These risk factors should be paid attention to in clinical practice.