Department of Orthopaedics, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Int J Cardiol. 2013 Jun 20;166(2):385-93. doi: 10.1016/j.ijcard.2011.10.114. Epub 2011 Nov 21.
Low bone mineral density (BMD) has been associated with increased mortality in prospective cohort studies of the elderly, but the real relationship is still controversial. We undertook a meta-analysis to evaluate the association of BMD with risk of all-cause, cardiovascular and stroke mortality.
We performed systematic searches on MEDLINE, EMBASE, OVID, CINAHL, and the Cochrane Library. Data extraction was performed independently by two reviewers. For each study, hazard ratios (HRs) and 95% confidence intervals (CI) per standard deviation (SD) decrease in BMD were extracted. Heterogeneity, publication bias, subgroup, and meta-regression analysis were performed.
The analysis included 46,182 participants from 10 studies with 3991 all-cause deaths, 1479 cardiovascular deaths and 403 stroke deaths during a median of 7 years follow-up (range 2.8-18.7 years). Lower BMD had a significant inverse relationship with all-cause and cardiovascular mortality, a per SD decrease in BMD at all sites being associated with a 1.17-fold (95% CI: 1.13-1.22) increase in total mortality and a 1.13-fold increase in cardiovascular mortality (95% CI: 1.06-1.20). Lower total hip/femoral neck BMD was also related to all-cause mortality (HR 1.20; 95% CI: 1.09-1.31) and cardiovascular mortality (HR 1.20; 95% CI: 1.04-1.35). BMD was not associated with the risk of stroke mortality (HR 1.08, 95% CI; 0.89-1.28).
Lower BMD is associated with significantly increased risk of all-cause and cardiovascular mortality. There is no significant association between lower BMD and the risk of stroke mortality. The relationship between lower BMD and individual mortality should be investigated further in randomized trials.
在对老年人的前瞻性队列研究中，低骨密度（BMD）与死亡率增加有关，但实际关系仍存在争议。我们进行了一项荟萃分析，以评估 BMD 与全因、心血管和卒中死亡率风险的关系。
我们在 MEDLINE、EMBASE、OVID、CINAHL 和 Cochrane 图书馆上进行了系统检索。由两名评审员独立进行数据提取。对于每项研究，我们提取了每标准偏差（SD）降低 BMD 的风险比（HR）和 95%置信区间（CI）。进行了异质性、发表偏倚、亚组和荟萃回归分析。
该分析纳入了 10 项研究中的 46182 名参与者，中位随访时间为 7 年（范围为 2.8-18.7 年），期间发生了 3991 例全因死亡、1479 例心血管死亡和 403 例卒中死亡。较低的 BMD 与全因和心血管死亡率呈显著负相关，全身各部位每 SD 降低 BMD 与总死亡率增加 1.17 倍（95%CI：1.13-1.22）和心血管死亡率增加 1.13 倍（95%CI：1.06-1.20）相关。总髋/股骨颈 BMD 降低也与全因死亡率（HR 1.20；95%CI：1.09-1.31）和心血管死亡率（HR 1.20；95%CI：1.04-1.35）相关。BMD 与卒中死亡率风险无相关性（HR 1.08，95%CI；0.89-1.28）。
较低的 BMD 与全因和心血管死亡率风险显著增加相关。较低的 BMD 与卒中死亡率风险之间没有显著关联。在随机试验中应进一步研究较低的 BMD 与个体死亡率之间的关系。
