老年女性髋部脆性骨折患者骨转换特征及其与血清高密度脂蛋白胆固醇的相关性

Characteristics of bone turnover in elderly women patients with fragile hip fractures and correlation with serum high-density lipoprotein cholesterol

目的探讨骨转换与老年女性髋部脆性骨折(fragile hip fracture,HF)风险及与高密度脂蛋白胆固醇(HDLc)的相关性。方法选取2021年1月至2022年12月年龄≥60岁女性住院骨质疏松症患者共661例,分为无骨折组(A组)266例和HF组(B组)395例。检测总胆固醇(Tch)、甘油三酯(TG)、HDLc、低密度脂蛋白胆固醇(LDLc)、骨钙素N段中分子片段(N-MID OC)、Ⅰ型胶原羧基端肽β特殊序列(β-CTX)、总蛋白(TP)、白蛋白(Alb)、钙(Ca)、磷(P)、镁(Mg)、尿素(Urea)、肌酐(Cr)、胱抑素C(Cys-C)、肾小球滤过率(eGFR)、骨形成率(MoMF)、骨吸收率(MoMR)及骨转化率(MoT)。结果(1)HF组TP[118(108,128)vs 124(114,131)]、Alb[38.4±3.7 vs 40.0±4.3]、HDLc[1.51(1.24,1.71)vs 1.54(1.37,1.73)]、Ca[2.21±0.12 vs 2.29±0.12]、P[1.03±0.16 vs 1.08±0.17]含量较无骨折组降低,年龄[76(68,83)vs 73(67,78)]、β-CTX[0.57(0.40,0.77)vs 0.34(0.19,0.56)]、MoMR[1.84(1.30,2.51)vs 1.09(0.61,1.83)]及MoT[2.16(1.56,2.85)vs 1.56(1.09,2.38)]较无骨折组增加,差异有统计学意义(P<0.05)。N-MID OC、MoMF、Urea、Cr、Cys-C、eGFR、Tch、TG、LDLc及Mg差异无统计学意义(P>0.05)。(2)老年女性HF与HDLc、TP、ALB、Ca、P、Mg呈负相关(r=-0.09、-0.26、-0.16、-0.28、-0.12、-0.03,P<0.05),与年龄、β-CTX、MoMR、MoT呈正相关(r=0.17、0.36、0.36、0.26,P<0.05),与N-MID OC、MoMF、Urea、Cr、Cys-C、eGFR、Tch、TG、LDLc无相关性(P>0.05)。(3)年龄、MoT、TP、Ca、P为老年女性HF的风险因素,OR分别为1.03(95%CI:1.01~1.06)、1.75(95%CI:1.44~2.12)、0.96(95%CI:0.92~0.99)、0.06(95%CI:0.01~0.37)、0.18(95%CI:0.06~0.6),P<0.05。(4)HDLc与骨转化间存在“U”型关系,P<0.01,其切点为1.692 mmol/L。结论高骨转换是老年女性HF的危险因素,其骨转化率与HDLc存在U型相关。

Objective To explore the relationship between bone turnover and the risk of fragile hip fracture(HF)and high-density lipoprotein cholesterol(HDLc)in elderly women.Methods A total of 661 female hospitalized osteoporosis patients aged over 60 years from January 2021 to December 2022 were selected,including 266 cases in the non fracture group(Group A)and 395 cases in the HF(Group B).Total cholesterol(Tch),triglyceride(TG),HDLc,low-density lipoprotein cholesterol(LDLc),osteocalcin N-segment middle molecular fragment(N-MID OC),type I collagen carboxyl terminal peptideβspecial sequence(β-CTX),total protein(TP),albumin(Alb),calcium(Ca),phosphorus(P),magnesium(Mg),urea(Urea),creatinine(Cr),cystatin C(Cys-C),glomerular filtration rate(eGFR),bone formation rate(MoM F),bone resorption rate(MoM R),and bone turnover rate(MoT)were detected.Results(1)Compared to those in non fracture group,the contents of TP[118(108128)vs 124(114131)],Alb[38.4±3.7 vs 40.0±4.3],HDLc[1.51(1.24,1.71)vs 1.54(1.37,1.73)],Ca[2.21±0.12 vs 2.29±0.12],P[1.03±0.16 vs 1.08±0.17]in hip fracture group decreased,but age[76(68,83)vs 73(67,78)],β-CTX[0.57(0.4,0.77)vs 0.34(0.19,0.56)],MoM R[1.84(1.3,2.51)vs 1.09(0.61,1.83)],and MoT[2.16(1.56,2.85)vs 1.56(1.09,2.38)]increased(P<0.05),and the difference was statistically significant.N-MID OC,MoM F,Urea,Cr,Cys-C,eGFR,Tch,TG,LDLc,and Mg were not statistically significant(P>0.05).(2)HF in elderly women was negatively correlated with HDLc,TP,ALB,Ca,P,and Mg(r=-0.09,-0.26,-0.16,-0.28,-0.12,-0.03,P<0.05).positively correlated with age,β-CTX,MoM R,and MoT(r=0.17,0.36,0.36,0.26,P<0.05),but was not correlated with N-MID OC,MoMF,Urea,Cr,Cys-C,eGFR,Tch,TG,and LDLc(P>0.05).(3)Age,MoT,TP,Ca,and P were risk factors for HF in elderly women,with ORs of 1.03(95%CI:1.01-1.06),1.75(95%CI:1.44-2.12),0.96(95%CI:0.92-0.99),0.06(95%CI:0.01-0.37),and 0.18(95%CI:0.06-0.6),respectively(P<0.05).(4)There was a U-shaped relationship between HDLc and bone turnover(P<0.01),with a cut-off point of 1.692 mmol/L.Conclusion High bone turnover is a risk factor for HF in elderly women with osteoporosis,and its bone turnover rate is U-shaped related to HDLc.