老年类风湿关节炎骨质疏松患者骨折风险及相关影响因素分析

Analysis of fracture risk and related influencing factors in elderly patients with rheumatoid arthritis and osteoporosis

目的分析研究老年类风湿关节炎(RA)骨质疏松(OP)患者骨折风险及相关影响因素。方法选取2021年1月至2023年12月江苏省中医院收治的2954例老年RA合并OP患者作为研究对象,采用骨折风险评估工具(FRAX)评估患者的10年内骨折发生风险,分为低风险组、中风险组及高风险组。收集患者的基本资料,采用多分类有序logistic回归分析老年RA合并OP患者10年内骨折发生风险的相关影响因素。结果FRAX测评显示,低风险组占比64.93%(1918/2954),中风险组占比28.06%(829/2954),高风险组占比7.01%(207/2954);三组性别、年龄、病程、身体质量指数(BMI)、骨折史及糖皮质激素服用比较差异有统计学意义(χ^(2)=67.110、133.590、93.176、59.301、96.498、83.292,均P<0.05);多分类有序logistic回归分析,女性、年龄≥70岁、病程≥10年、BMI≤24 kg/m^(2)、有骨折史及有糖皮质激素服用均是老年RA合并OP患者10年内骨折发生中风险的独立危险因素(P<0.05);女性、年龄≥70岁、病程≥10年、BMI≤24 kg/m^(2)、有骨折史及有糖皮质激素服用均是老年RA合并OP患者10年内骨折发生高风险的独立危险因素(P<0.05)。结论老年RA合并OP患者骨折风险受到多种因素影响,应根据相关危险因素采取针对性措施干预,以减少骨折发生。

Objective To analyze the risk of fracture and related factors in elderly patients with rheumatoid arthritis(RA)and osteoporosis(OP).Methods 2954 elderly patients with RA combined with OP admitted to Jiangsu Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were retrospectively selected as the study subjects.The fracture risk assessment tool(FRAX)was used to assess the risk of fracture within the next 10 years and categorize patients into low⁃risk,medium⁃risk,and high⁃risk groups.Basic data was collected,and multivariate logistic regression was employed to analyze the factors influencing fracture risk in elderly patients with RA and OP over a 10⁃year period.Results FRAX evaluation showed that 64.93%(1918/2954)of the patients were in the low⁃risk group,28.06%(829/2954)were in the medium⁃risk group,and 7.01%(207/2954)were in the high⁃risk group.There were significant differences in gender,age,duration of disease,body mass index(BMI),fracture history,and glucocorticoid use among the three groups(χ^(2)=67.110,133.590,93.176,59.301,96.498,83.292,P<0.05).Multi⁃classification ordered logistic regression analysis indicated that being female,age≥70 years,disease duration≥10 years,BMI≤24 kg/m^(2),history of fracture,and glucocorticoid use were all independent risk factors for fractures in elderly RA patients with OP within 10 years(P<0.05).Specifically,being female(OR=2.040),age≥70 years(OR=1.998),disease duration≥10 years(OR=1.988),BMI≤24 kg/m2(OR=2.059),history of fracture(OR=1.902),and glucocorticoid use(OR=2.234)were identified as independent risk factors of fractures within 10 years in elderly RA patients with OP(P<0.05).Conclusion The fracture risk of elderly RA patients with OP ix influenced by numerous factors.Targeted interventions should be implemented based on these risk factors to decrease the likelihood of fractures.