新型冠状病毒感染对骨质疏松症患者骨代谢的影响

Effect of coronavirus disease 2019 on bone metabolism in patients with osteoporosis

目的 分析新型冠状病毒感染(coronavirus disease 2019,COVID-19)对骨质疏松症患者骨代谢的影响。方法 回顾性分析2022年11月至2023年3月于上海市第一人民医院就诊且已确诊感染新型冠状病毒的骨质疏松症患者98例。统一记录所有患者新型冠状病毒(SARS-CoV-2)感染前后的骨代谢指标、新型冠状病毒核酸阳性持续时间,新型冠状病毒核酸阳性期间服药史(是否停用抗骨质疏松药物,钙剂或活性维生素D及类固醇类激素服用史),以及基础病史及既往疫苗接种情况。采用SPSS.26进行统计学分析。结果骨质疏松症患者感染新型冠状病毒后血清骨钙素(bone gla protein, BGP)及1型原胶原氨基端前肽(type 1 procollagen amino-terminal peptide, P1NP)水平[9.915(8.260,11.873)μg/L及20.250(15.080,28.930)μg/L]均较感染前[10.365(8.395,29.3150)μg/L及22.135(16.330,33.085)μg/L]降低(均P<0.01)。停用钙剂或活性维生素D骨质疏松症患者的血清25羟维生素D(25 hydroxyvitamin D,25OHD)水平[4.155(-0.135,15.078)nmol/L]较未停用钙剂或活性维生素D骨质疏松症患者[-0.485(-8.465,8.695)nmol/L]升高(P<0.05);服用激素骨质疏松症患者的血清骨碱性磷酸酶(bone alkaline phosphatase, BAP)水平[1.520(1.320,6.190)μg/L]较未服用激素的骨质疏松症患者[0.370(-0.950,1.270)μg/L]升高(P<0.05);新型冠状病毒核酸阳性持续时间与感染前后血清25OHD水平及25OHD变化无明显相关。结论 新型冠状病毒感染使得骨质疏松症患者的骨形成受抑,血清BGP及P1NP水平均较感染前降低。骨质疏松症患者血清25OHD水平与新型冠状病毒感染无明显相关。

Objective To analyze the effect of coronavirus disease 2019(COVID-19)on bone metabolism in patients with osteoporosis.Methods A retrospective analysis was performed on 98 patients with osteoporosis who were diagnosed with COVID-19 and attended Shanghai General Hospital from November 2022 to March 2023.We uniformly recorded bone metabolic markers and positive duration of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),medication history history of anti-osteoporosis drugs,calcium or vitamin D withdrawal and steroids application during SARS-CoV-2 positive time,and history of underlying medical conditions and vaccinations.SPSS.26 was used for statistical analysis.Results Serum bone gla protein(BGP)and type 1 procollagen amino-terminal peptide(P1NP)levels[9.915(8.260,11.873)μg/L and 20.250(15.080,28.930)μg/L]were lower in patients with osteoporosis after infection with SARS-CoV-2 than before infection[10.365(8.395,29.3150)μg/L and 22.135(16.330,33.085)μg/L](both P<0.01).The change in serum 25 hydroxyvitamin D(25OHD)levels[4.155(-0.135,15.078)nmol/L]was greater in patients with osteoporosis who stopped taking calcium or vitamin D than in patients with osteoporosis who did not stop taking calcium or vitamin D[-0.485(-8.465,8.695)nmol/L](P<0.05).The changes in serum bone alkaline phosphatase(BAP)were greater in osteoporosis patients taking steroids[1.520(1.320,6.190)μg/L]than in osteoporosis patients not taking steroids[0.370(-0.950,1.270)μg/L](P<0.05).Duration of SARS-CoV-2 positive was not significantly correlated with serum 25OHD levels and 25OHD changes before and after infection.Conclusion COVID-19 depresses bone formation in patients with osteoporosis,and serum BGP and P1NP levels are reduced compared to pre-infection levels.Serum 25OHD level in osteoporotic patients is not significantly correlated with COVID-19.