围绝经期及绝经后期女性人体体成分与腰椎骨密度的相关分析

Correlation analysis between body composition and lumbar bone mineral density in perimenopausal and postmenopausal women

目的探讨围绝经期及绝经后期女性人体体成分与腰椎骨密度(bone mineral density,BMD)之间的关系,进一步分析该人群骨量减少的影响因素。方法招募2021年10月至2024年3月于首都医科大学附属北京妇产医院内分泌科就诊的围绝经期及绝经后期女性300例为研究对象。采用定量电子计算机断层扫描技术(quantitative computed tomography,QCT)测量腰椎骨密度,根据测量结果分为骨量正常组和骨量减少组,采用肌肉功能分析仪测定所有受试者的体质量、脂肪、下肢肌肉、膝关节活动等人体成分情况,采用更年期症状全面评估量表采集所有研究对象的年龄、绝经状态及活动类型。采用单因素方差分析比较骨量正常组和骨量减少组的人体体成分之间的差异性,采用多因素Logistic回归分析探讨骨量减少的危险因素。结果300例研究对象中,围绝经期女性148例(49%),平均年龄(51.40±5.03)岁;绝经后期女性152例(51%),平均年龄(53.59±6.04)岁。绝经后期女性的骨密度低于围绝经期女性,差异有统计学意义(P<0.05)。骨量减少组118例(39%),骨量正常组182例(61%)。骨量减少组女性年龄、脂肪百分比、绝经后期占比和无锻炼占比均高于骨量正常组,差异有统计学意义(P<0.05);而下肢肌肉分布系数、下肢肌力和有锻炼占比均低于骨量正常组,差异有统计学意义(P<0.05)。Spearman相关性分析结果表明围绝经期和绝经后期女性BMD与年龄、脂肪百分比、绝经后期占比均呈显著负相关(r=-0.492、-0.125、-0.287,P<0.05),而与下肢肌肉分布系数、下肢肌力、有锻炼占比均呈显著正相关(r=0.143、0.180、0.193,P<0.05)。二元Logistic回归分析结果显示,年龄大、脂肪百分比大、下肢肌肉分布少、锻炼少是骨量减少的危险因素(P<0.05)。结论与围绝经期女性相比,绝经后期女性的腰椎骨密度明显降低,围绝经期及绝经后期女性腰椎骨密度与人体体成分及活动类型密切相关,其中年龄大、脂肪百分比大、下肢肌肉分布少、锻炼少是骨量减少的危险因素(P<0.05)。建议临床医生关注此时期女性的腰椎骨密度及人体体成分的变化,以便通过及时合理的干预措施来提高她们的生活质量,预防骨质疏松的发生。

Objective To explore the relationship between body composition and lumbar bone mineral density(BMD)in perimenopausal and postmenopausal women,and to further analyze the influencing factors of bone loss in this population.Methods A total of 300 perimenopausal and postmenopausal women who were admitted to the Department of Endocrinology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University from October 2021 to March 2024 were recruited as subjects.The age,menopausal status,and activity type of all subjects were collected with the menopausal symptom comprehensive assessment scale.The bone density of the lumbar spine was measured with quantitative computed tomography(QCT)and the subjects were divided into normal bone mass group and low bone mass group,according to the measurement results.The body composition of all subjects,such as body weight,fat,lower limb muscle,and knee joint activity was measured with muscle function analyzer.One-Way analysis of variance was used to compare the differences in body composition between the normal bone mass group and the osteopenia group.Multivariate Logistic regression analysis was used to explore the risk factors of osteopenia.Results Among the 300 subjects,there were 148(49%)perimenopausal women,with an average age of(51.40±5.03)years and 152 postmenopausal women(51%),with an average age of(53.59±6.04)years.The BMD of postmenopausal women was significantly lower than that of perimenopausal women(P<0.05).There were 118 cases(39%)in the low bone mass group and 182 cases(61%)in the normal bone mass group.The age,percentage of fat,proportion of postmenopausal women and proportion of women without exercise in low bone mass group were significantly higher than those in normal bone mass group(P<0.05).The lower limb muscle distribution coefficient,lower limb muscle strength,and the proportion of exercise were significantly lower than those in the normal bone mass group(P<0.05),respectively.Spearman correlation analysis showed that BMD in perimenopausal and postmenopausal women was significantly negatively correlated with age,fat percentage,and proportion of postmenopausal women(r=-0.492,-0.125,-0.287,P<0.05),while it was significantly positively correlated with lower limb muscle distribution coefficient,lower limb muscle strength,and proportion of exercise(r=0.143,0.180,0.193,P<0.05).Binary Logistic regression analysis showed that older age,higher percentage of fat,less muscle distribution of lower limbs,and less exercise were risk factors for bone loss(P<0.05).Conclusions Compared with perimenopausal women,the BMD of lumbar vertebrae in postmenopausal women was significantly lower.The BMD of lumbar vertebrae in perimenopausal and postmenopausal women was closely related to body composition and activity type.Older age,higher percentage of fat,less muscle distribution of lower limbs and less exercise were risk factors for bone loss(P<0.05).It is suggested that clinicians should pay attention to the changes of lumbar BMD and body composition of women in this period,so as to improve their quality of life and prevent the occurrence of osteoporosis through timely and reasonable intervention measures.