中老年人维生素D、骨密度水平与髋部脆性骨折的相关性研究  

Correlation between vitamin D,BMD and fragility fracture of hip in middle-aged and elderly people

作　　者：张少波 刘芳[1] 彭岳文 古振 ZHANG Shaobo;LIU Fang;PENG Yuewen;GU Zhen(Department of Orthopaedics,Yueyang Hospital Affiliated to Hunan Normal University,The People’s Hospital of Yueyang,Yueyang 414000,China)

机构地区：[1]湖南师范大学附属岳阳医院,岳阳市人民医院骨科,湖南岳阳414000

出　　处：《中国骨质疏松杂志》2022年第6期812-817,824,共7页Chinese Journal of Osteoporosis

摘　　要：目的探讨中老年人维生素D(VitD)、骨密度(bone mineral density,BMD)水平与髋部脆性骨折的相关性。方法选取2019年1月至2020年8月在岳阳市人民医院接受治疗的50岁以上患者830例,骨折患者135例(骨折组),非骨折患者695例(非骨折组)。采集所有研究对象的血清,用电化学发光法测定血清25(OH)D水平,应用双能X线吸收仪测定其腰椎及髋部BMD,并在测定骨密度的同时测量患者身高、体重,计算体质量指数(body mass index,BMI),观察骨折组与非骨折组之间的VitD与BMD差异。结果①所有研究对象中25(OH)D严重缺乏者占16.1%、缺乏者占34.7%、轻度缺乏者占29.8%、充足者占19.4%,男性VitD水平高于女性(P<0.001)。而不同年龄和BMI的VitD水平无统计学差异(P=0.878、0.346);②所有研究对象的腰椎、股骨颈BMD(T值)平均为-2.64±1.56及-1.43±1.24,不同性别、年龄、体质量指数研究对象的腰椎及股骨颈BMD水平差异有统计学意义(P<0.001);③髋部骨折组平均VitD为(20.26±10.76)ng/mL,非骨折组为(21.18±10.65)ng/mL,两组间无显著差异(P=0.304);④髋部骨折组腰椎、股骨颈T值低于非骨折组(P<0.001)。对骨折影响因素行单因素分析表明VitD、腰椎T值和股骨颈T值、年龄、体质量指数是髋部脆性骨折的危险因素(P<0.05)。多因素分析表明年龄、体质量指数、股骨颈T值是髋部骨折的独立危险因素(P<0.05),而VitD与腰椎T值对骨折的影响呈现一定的风险增大趋势,但无统计学意义。结论岳阳地区50岁以上人群存在较低的BMD及VitD水平。年龄、体重、体质量指数、股骨颈BMD是中老年人髋部骨折的独立危险因素,VitD不是髋部骨折的独立危险因素。Objective To investigate the Correlation between Vitamin D(VitD),Bone Mineral Density(BMD)and fragility fracture of hip in middle-aged and elderly people.Methods A total of 830 patients over 50 years old who received treatment in Yueyang People’s Hospital from January 2019 to August 2020 were selected,including 135 fracture patients and 695 non-fracture patients.The serum of all subjects was collected,the serum levels of 25-hydroxyvitamin D[25(OH)D]were measured by electrochemiluminescence immunoassay.Their BMD of lumbar vertebrae and hip were measured by dual-energy X-ray absorptiometry.Height,weight and body mass index(BMI)were measured at the same time as BMD,and VitD and BMD differences between fracture group and non-fracture group were observed.Results①Among the all participators,the prevalence of Vitamin D severe deficiency,deficiency,insufficiency and sufficiency accouted for 16.1%,34.7%,29.8%and 19.4%respectively.The 25(OH)D levels in male participators were significantly higher than female(P<0.001),and there was no statistically significant difference in level of VitD in different age and body mass index(BMI)groups(P=0.878,0.346);②The average values of BMD of lumbar spine and neck of femur were-2.64±1.56 and-1.43±1.24 respectively.There were statistically significant difference in the values of BMD of lumbar spine and neck of femur in different sex,age and BMI groups(P<0.001);③The average 25(OH)D levels was 20.26±10.76 ng/mL in hip fracture group,and 21.18±10.65 ng/mL in non-fracture group.The difference of 25(OH)D levels between hip fracture group and non-fracture group was no statistically significant(P=0.304);④The average values of BMD of lumbar spine and neck of femur were-3.28±1.52 and-2.08±0.99 respectively in hip fracture group,and-2.52±1.54,-1.31±1.24 respectively in non-fracture group.The difference of the values of BMD of lumbar spine and neck of femur between hip fracture group and non-fracture group was statistically significant(P<0.001).The single factor analysis showed tha

关 键 词：25羟维生素D 维生素D缺乏 骨密度 髋部骨折 

分 类 号：R683.42[医药卫生—骨科学]