绝经后女性骨质疏松及骨质疏松性骨折的危险因素分析

Analysis of risk factors for osteoporosis and osteoporotic fractures in postmenopausal women

目的探讨绝经后女性发生骨质疏松症(OP)及骨质疏松性骨折的危险因素。方法回顾性选取2021年9月至2023年5月于达州市中心医院就诊的1047例绝经后女性为研究对象,根据骨密度(BMD)测量值,将其分为OP组和非OP(NOP)组;根据是否发生骨质疏松性骨折将OP组患者分又为骨折组和非骨折组。采用多因素Logistic回归分析导致OP或骨质疏松性骨折的影响因素;绘制受试者工作特征(ROC)曲线分析血清同型半胱氨酸(HCY)、前清蛋白(PA)对OP或骨质疏松性骨折的诊断价值。结果OP组患者年龄、合并高血压比例及尿素、HCY水平高于NOP组,而体质量指数(BMI)、全髋关节BMD T评分、腰椎BMD T评分、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、清蛋白、PA、Ca^(2+)、总胆固醇、低密度脂蛋白水平低于NOP组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄增加、血清HCY水平升高及BMI、PA水平降低均是绝经后女性发生OP的危险因素(P<0.05)。ROC曲线结果显示,年龄、BMI、HCY、PA联合预测OP的曲线下面积(AUC)为0.743,明显高于各指标单独预测的AUC(P<0.05)。骨折组血清PA水平低于非骨折组,而HCY水平高于非骨折组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血清HCY水平升高、PA水平降低是导致绝经后女性OP患者发生骨质疏松性骨折的危险因素(P<0.05)。ROC曲线结果显示,血清HCY、PA单独及联合预测绝经后女性骨质疏松性骨折的AUC分别为0.725、0.602和0.742。结论血清HCY和PA水平变化能较好地预测绝经后女性骨质疏松性骨折的发生,但是在预测OP发生方面的性能较差,而年龄、BMI在预测OP发生方面有一定的价值。

Objective To investigate the risk factors for osteoporosis(OP)and osteoporotic fracture in postmenopausal women.Methods A total of 1047 postmenopausal women attending Dazhou City Central Hospital from September 2021 to May 2023 were retrospectively selected as the study subjects,who were divided into the OP group and the non-OP(NOP)group according to the size of bone mineral density(BMD)measurements,and the patients in the OP group were subdivided into the fracture group and the non-fracture group according to the occurrence of osteoporotic fractures.Multivariate Logistic regression analysis was used to analyze influencing factors for OP or osteoporotic fracture;receiver operating characteristic(ROC)curve was plotted to analyze the diagnostic value of serum homocysteine(HCY)and prealbumin(PA)for OP or osteoporotic fracture.Results The age,the proportion of patients with a history of hypertension and the levels of Urea and HCY in the OP group were higher than those in the NOP group,whereas the body mass index(BMI),T scores of total hip BMD and lumbar spine BMD,ALT,AST,albumin,PA,Ca^(2+),total cholesterol and low-density lipoprotein levels were lower than those in the NOP group,and the differences were all statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that age,elevated serum HCY level and decreased BMI and PA level were risk factors for OP(P<0.05).The results of ROC curve showed that the area under the curve(AUC)of joint detection of age,BMI,HCY and PA for prediction of OP was 0.743,which was significantly higher than that predicted by the individual indicators alone(P<0.05).Serum PA level in the fracture group was lower than that in the non-fracture group,whereas HCY level was higher than that in the non-fracture group,and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that increased serum HCY level and decreased PA level were risk factors for osteoporotic fracture in patients with OP(P<0.05).The results of ROC curves showed that the AUCs of serum H CY and PA alone and in combination for predicting osteoporotic fracture were 0.725,0.602 and 0.742,respectively.Conclusion According to the changes of serum HCY and PA levels can better predict the occurrence of osteoporotic fracture in p ostmenopausal women,but the performance in predicting the occurrence of OP is poor,while age and BMI have some value in predicting the occurrence of OP.