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钙调节激素与老年人髋部和非脊柱骨折风险:健康老龄化纵向研究。

Calciotropic hormones and the risk of hip and nonspine fractures in older adults: the Health ABC Study.

机构信息

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA.

出版信息

J Bone Miner Res. 2012 May;27(5):1177-85. doi: 10.1002/jbmr.1545.

Abstract

The effects of vitamin D and parathyroid hormone (PTH) levels on incident fracture remain uncertain. To test the hypothesis that increasing serum 25-hydroxyvitamin D [25(OH)D] and decreasing PTH levels are associated with decreased risk of hip and any nonspine fracture, we conducted a prospective cohort study among 2614 community-dwelling white and black participants, aged ≥70 years, from the Health, Aging and Body Composition (Health ABC) Study. Serum and plasma samples were drawn at year 2, which formed the baseline for this analysis. Serum 25(OH)D and intact PTH (1-84) were measured using radioimmunoassay with DiaSorin reagents and EDTA plasma with a two-site immunoradiometric assay kit, respectively. Incident fractures (hip and any nonspine) were assessed after year 2, every 6 months, by self-report and validated by radiology reports. The median (interquartile range) follow-up times for hip and any nonspine fractures were 6.4 (6.1-6.5) and 6.4 (5.5-6.5) years, respectively. Cox proportional hazards regression was used to estimate the hazard ratios (HR) with 95% confidence intervals (CI) for fracture. There were 84 hip and 247 nonspine fractures that occurred over the follow-up period. The multivariable adjusted HRs (95% CIs) of hip fracture for participants in the lowest (≤17.78 ng/mL), second (17.79 to 24.36 ng/mL), and third quartiles (24.37 to 31.94 ng/mL) of 25(OH)D were 1.92 (0.97 to 3.83), 0.75 (0.32 to 1.72) and 1.86 (1.00 to 3.45), respectively, compared with participants in the highest 25(OH)D quartile (>31.94 ng/mL) (p trend = 0.217). Additional adjustment for IL-6 (p = 0.107), PTH (p = 0.124), and hip areal bone mineral density (p = 0.137) attenuated HRs of hip fracture in the lowest quartile by 16.3%, 17.4%, and 26.1%, respectively. There was no evidence of an association between 25(OH)D and any nonspine fractures, or between PTH and hip or any nonspine fractures. We found limited evidence to support an association between calciotropic hormones and hip and nonspine fractures in older men and women.

摘要

维生素 D 和甲状旁腺激素 (PTH) 水平对骨折发生的影响仍不确定。为了检验血清 25-羟维生素 D [25(OH)D] 升高和 PTH 水平降低与髋部和任何非脊柱骨折风险降低相关的假设,我们对来自健康、老龄化和身体成分研究(Health ABC 研究)的 2614 名居住在社区的白人和黑人参与者进行了前瞻性队列研究。在第 2 年抽取血清和血浆样本,作为本分析的基线。使用 DiaSorin 试剂的放射免疫分析法测量血清 25(OH)D,使用 EDTA 血浆的双位点免疫放射分析法试剂盒测量完整的 PTH(1-84)。在第 2 年后,每 6 个月通过自我报告和放射学报告评估髋部和任何非脊柱骨折。髋部和任何非脊柱骨折的中位(四分位距)随访时间分别为 6.4(6.1-6.5)和 6.4(5.5-6.5)年。使用 Cox 比例风险回归估计骨折的风险比(HR)及其 95%置信区间(CI)。在随访期间发生了 84 例髋部骨折和 247 例非脊柱骨折。25(OH)D 最低(≤17.78ng/mL)、第二(17.79 至 24.36ng/mL)和第三四分位数(24.37 至 31.94ng/mL)的参与者髋部骨折的多变量调整 HR(95%CI)分别为 1.92(0.97 至 3.83)、0.75(0.32 至 1.72)和 1.86(1.00 至 3.45),与 25(OH)D 最高四分位数(>31.94ng/mL)的参与者相比(p趋势=0.217)。进一步调整白细胞介素 6(p=0.107)、PTH(p=0.124)和髋部面积骨密度(p=0.137),可分别使最低四分位数髋部骨折的 HR 降低 16.3%、17.4%和 26.1%。25(OH)D 与任何非脊柱骨折之间或 PTH 与髋部或任何非脊柱骨折之间均无关联的证据。我们发现了有限的证据支持钙调节激素与老年男性和女性髋部和非脊柱骨折之间的关联。

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