3608例中老年人骨代谢指标对骨质疏松及骨折风险的预测  

Bone metabolic markers predict the risk of osteoporosis and fracture in 3608 middle-aged and elderly patients

作　　者：郭勇 张颖 栗敏 杨华 贺丹丹 张智海 GUO Yong;ZHANG Ying;LI Min;YANG Hua;HE Dandan;ZHANG Zhihai(Department of Hospital,Daxing Teaching Hospital,Capital Medical University,Beijing 102600;Department of Oncology,Daxing Teaching Hospital,Capital Medical University,Beijing 102600;Department of Radiology,Integrated Traditional Chinese and Western Medicine Hospital of Daxing District,Beijing 100076;Department of Inspection,Integrated Traditional Chinese and Western Medicine Hospital of Daxing District,Beijing 100076;Department of Bone Density,Integrated Traditional Chinese and Western Medicine Hospital of Daxing District,Beijing 100076;Department of Orthopedics,Guang’anmen Hospital,Chinese Academy of Traditional Chinese Medicine,Beijing 100053,China)

机构地区：[1]首都医科大学大兴教学医院院部,北京102600 [2]首都医科大学大兴教学医院肿瘤科,北京102600 [3]北京市大兴区中西医结合医院放射科,北京100076 [4]北京市大兴区中西医结合医院检验科,北京100076 [5]北京市大兴区中西医结合医院骨密度室,北京100076 [6]中国中医科学院广安门医院骨科,北京100053

出　　处：《中国骨质疏松杂志》2024年第10期1432-1437,共6页Chinese Journal of Osteoporosis

基　　金：国际课题“IOF对骨量减少人群骨折风险评估(FRAX)前瞻性研究”(IOFCJO-D001);北京市大兴区预防医学会科研项目(XHKY202405)。

摘　　要：目的探讨北京南郊中老年人骨代谢指标与骨密度的相关性,以及在骨质疏松症及骨折风险预测中的价值。方法以2017年4月至2023年4月在首都医科大学大兴教学医院行骨密度(bone mineral density,BMD)检查的中老年患者3608例作为研究对象,收集性别、年龄、BMD、25(OH)D_(3)、N-MID、PTH等指标,比较骨代谢指标在不同骨量及性别间的差异,各指标之间的相关性,建立10年主要骨质疏松性骨折风险(FRAX-MOF)和髋部骨折风险(FRAX-HF)回归方程,绘制不同指标诊断骨量减少或骨质疏松的ROC曲线。结果女性FRAX骨折风险高于男性,女性在各骨量组的N-MID高于男性但25(OH)D_(3)含量低于男性,年龄、N-MID与BMD呈负相关(r=-0.87),与MOF、HF呈正相关(年龄:r=0.87和0.96,N-MID:r=0.87和0.77)。BMI与BMD呈正相关(r=0.67),与MOF、HF呈负相关(r=-0.67和-0.70),差异均有统计学意义。构建HF回归方程模型:Y=-1.051+0.057×年龄-0.222×性别-0.041×BMI-0.508×BMD-0.003×N-MID-0.003×25(OH)D_(3),R^(2)=0.724,P=0.000。N-MID预测骨质疏松(T值≤-2.5)和骨量减少(T值<-1)的AUC值为0.62和0.60,差异有统计学意义。结论N-MID与BMD有较好的相关性,在骨质疏松和FRAX-HF的早期识别中可能发挥作用。血清25(OH)D_(3)及PTH对于骨量变化及骨折风险的识别价值,可能更需要结合性别、年龄及基础疾病等情况综合考虑。Objective Investigate the relationship between bone density,bone metabolism markers in middle-aged and elderly from southern suburban Beijing,and their predictive value for osteoporosis and fracture risk.Methods Analyzed data from 3,608 subjects undergoing BMD tests between April 2017-April 2023,including gender,age,BMD,25(OH)D 3,N-MID,PTH and so on.Explored differences in bone metabolism markers across bone mass levels,genders,and their correlations.Developed regression models for 10-year FRAX-MOF and FRAX-HF,and ROC curves for osteoporosis and osteopenia.Results The FRAX fracture risk was higher in women than in men.Women had higher N-MID but lower 25(OH)D 3 levels than men,with statistically significant differences.Age negatively correlated with BMD(r=-0.87)and positively with MOF and HF(r=0.87,0.96),while BMI was positively correlated with BMD(r=0.67)and negatively with MOF and HF(r=-0.67,-0.70).N-MID showed a negative correlation with BMD(r=-0.87)and a positive one with MOF and HF(r=0.87,0.77).A regression model for HF was Y=-1.051+0.057×Age-0.222×Gender-0.041×BMI-0.508×BMD-0.003×N-MID-0.003×25(OH)D 3,with R^(2)=0.724,P<0.001.For osteoporosis and osteopenia,N-MID showed significant AUC values of 0.62 and 0.60,respectively.Conclusion N-MID correlates well with BMD,indicating potential in early osteoporosis and FRAX-HFdetection.The efficacy of 25(OH)D 3 and PTH in assessing bone mass changes and fracture risk should be evaluated alongside demographic and health factors.

关 键 词：骨质疏松 FRAX 25(OH)D_(3) 骨钙素N端中分子片段 甲状旁腺素 骨密度 

分 类 号：R443.8[医药卫生—诊断学] R683[医药卫生—临床医学]