Nguyen Nguyen D, Center Jacqueline R, Eisman John A, Nguyen Tuan V
Bone and Mineral Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia.
J Bone Miner Res. 2007 Aug;22(8):1147-54. doi: 10.1359/jbmr.070412.
Low baseline BMD, rate of BMD loss, weight loss, and weight fluctuation are significant predictors of all-cause mortality in elderly men and women, independent of each other and of age, incident fracture, and concomitant diseases.
Although low BMD has been shown to be associated with mortality in women, the effect of BMD is affected by weight and weight change and the contribution of these factors to mortality risk, particularly in men, is not known. This study examined the association between baseline BMD, rate of bone loss, weight loss, and weight fluctuation and all-cause mortality risk in elderly men and women.
Data from 1059 women and 644 men, >or=60 years of age (as of 1989), of white background who participated in the Dubbo Osteoporosis Epidemiology Study were analyzed. All-cause mortality was recorded annually between 1989 and 2004. BMD at the femoral neck was measured by DXA (GE-LUNAR) at baseline and at approximately every 2 yr afterward. Data on incident osteoporotic fractures and concomitant diseases, including cardiovascular diseases, all types of cancer, and type I/II diabetes mellitus, was also recorded.
In the multivariable Cox's proportional hazards model with adjustment for age, incident fractures, and concomitant diseases, the following variables were independent risk factors of all-cause mortality in men: rate of BMD loss of at least 1%/yr, rate of weight loss of at least 1%/yr, and weight fluctuation (defined by the CV) of at least 3%. In women, in addition to the significant factors observed in men, lower baseline BMD was also an independent risk factor of mortality. In both sexes, baseline weight was not an independent and significant predictor of mortality risk. Approximately 36% and 22% of deaths in women and men, respectively, were attributable to the four risk factors.
These data suggest that, although low BMD was a risk factor of mortality in women, it was not a risk factor of mortality in men. However, high rates of BMD loss, weight loss, and weight fluctuation were also independent predictors of all-cause mortality in elderly men and women, independent of age, incident fracture, and concomitant diseases.
低基线骨密度、骨密度丢失率、体重减轻和体重波动是老年男性和女性全因死亡率的重要预测因素，它们相互独立，且独立于年龄、骨折发生率和伴发疾病。
虽然低骨密度已被证明与女性死亡率相关，但骨密度的影响受体重和体重变化的影响，而这些因素对死亡风险的贡献，尤其是在男性中，尚不清楚。本研究探讨了基线骨密度、骨丢失率、体重减轻和体重波动与老年男性和女性全因死亡风险之间的关联。
分析了参与达博骨质疏松症流行病学研究的1059名女性和644名男性（截至1989年年龄≥60岁）的白人背景数据。1989年至2004年期间每年记录全因死亡率。基线时以及此后大约每2年通过双能X线吸收法（GE-LUNAR）测量股骨颈骨密度。还记录了骨质疏松性骨折发生率和伴发疾病的数据，包括心血管疾病、各类癌症以及I/II型糖尿病。
在对年龄、骨折发生率和伴发疾病进行调整的多变量Cox比例风险模型中，以下变量是男性全因死亡的独立危险因素：骨密度丢失率至少为每年1%、体重减轻率至少为每年1%以及体重波动（由变异系数定义）至少为3%。在女性中，除了在男性中观察到的显著因素外，较低的基线骨密度也是死亡的独立危险因素。在两性中，基线体重都不是死亡风险的独立且显著的预测因素。女性和男性死亡中分别约有36%和22%可归因于这四个危险因素。
这些数据表明，虽然低骨密度是女性死亡的危险因素，但不是男性死亡的危险因素。然而，高骨密度丢失率、体重减轻和体重波动也是老年男性和女性全因死亡的独立预测因素，独立于年龄、骨折发生率和伴发疾病。
