Department of Orthopaedic Surgery, Bispebjerg University Hospital, Copenhagen, Denmark.
Injury. 2012 Jul;43(7):1052-7. doi: 10.1016/j.injury.2011.12.025. Epub 2012 Jan 17.
Previously, little attention has been paid as to how disturbances in the parathyroid hormone (PTH)-calcium-vitamin D-axis, such as secondary hyperparathyroidism (SHPT), relate to mortality amongst hip fracture patients. This study aimed to (1) determine if SHPT is associated with mortality in this group of patients, (2) investigate the association between serum (s-) PTH, s-total calcium, s-25-hydroxyvitamin D (s-25(OH)D) and mortality and (3) determine the prevalence of SHPT amongst hip fracture patients and a control group.
The study included 562 hip fracture patients (HF) (age ≥ 70 years) admitted to a Danish university hospital. The hip fracture patients were prospectively enrolled in a dedicated hip fracture database. Each hip fracture patient was exactly matched according to age and sex with two controls randomly chosen from a control population of 21,778 subjects who had s-PTH, s-total calcium and s-25(OH)D measured at the Copenhagen General Practitioners Laboratory after referral from their general practitioner. The control group (Con) thus consisted of 1124 subjects.
General 1-year mortality: Con-female 8.4%, Con-male 15.3%, HF-female 24.6%, HF-male 33.3%, p<0.0001 (log rank). SHPT AND RELATED 1-YEAR MORTALITY: Con-no SHPT 8.9%, Con-SHPT 16.8%, HF-no SHPT 22.7%, HF-SHPT 34.9%, p<0.0001 (log rank). The mortality rates were higher for controls with SHPT (OR 2.06, 95% CI: 1.32-3.23), hip fracture patients without SHPT (OR 3.00, 95% CI: 2.14-4.20) and hip fracture patients with SHPT (OR 5.46, 95% CI: 3.32-8.97) compared to the controls without SHPT. PREVALENCE OF SHPT: Con 16%, HF 20%, p=0.09 (Chi-square).
Our study clearly shows that SHPT is significantly associated with mortality in both hip fracture patients and the control group. In the multivariate Cox regression analysis, s-PTH and s-total calcium were both significantly associated with mortality, whereas s-25(OH)D was not associated with mortality in this analysis. Our study furthermore indicates that SHPT is almost equally prevalent amongst the hip fracture patients and the control group.
此前，人们对甲状旁腺激素（PTH）-钙-维生素 D 轴紊乱（如继发性甲状旁腺功能亢进症[SHPT]）与髋部骨折患者死亡率之间的关系关注甚少。本研究旨在：（1）确定 SHPT 是否与该组患者的死亡率相关；（2）研究血清（s-）PTH、s-总钙、s-25-羟维生素 D（s-25（OH）D）与死亡率之间的关系；（3）确定髋部骨折患者和对照组中 SHPT 的患病率。
本研究纳入了 562 名（年龄≥70 岁）丹麦大学医院收治的髋部骨折患者（HF）。髋部骨折患者前瞻性地纳入专门的髋部骨折数据库。每例髋部骨折患者均根据年龄和性别与 21778 名对照组患者中的 2 名随机匹配，这些患者在被全科医生转介至哥本哈根全科医生实验室后，测量了 s-PTH、s-总钙和 s-25（OH）D。对照组（Con）由此包含 1124 名患者。
总体 1 年死亡率：Con-女性 8.4%，Con-男性 15.3%，HF-女性 24.6%，HF-男性 33.3%，p<0.0001（对数秩检验）。SHPT 及相关的 1 年死亡率：Con-无 SHPT 8.9%，Con-SHPT 16.8%，HF-无 SHPT 22.7%，HF-SHPT 34.9%，p<0.0001（对数秩检验）。SHPT 组的死亡率（OR 2.06，95%CI：1.32-3.23）、无 SHPT 的髋部骨折患者（OR 3.00，95%CI：2.14-4.20）和有 SHPT 的髋部骨折患者（OR 5.46，95%CI：3.32-8.97）均高于无 SHPT 的对照组。SHPT 的患病率：Con16%，HF20%，p=0.09（卡方检验）。
我们的研究清楚地表明，SHPT 与髋部骨折患者和对照组的死亡率显著相关。在多变量 Cox 回归分析中，s-PTH 和 s-总钙均与死亡率显著相关，而 s-25（OH）D 与死亡率无关。我们的研究还表明，SHPT 在髋部骨折患者和对照组中的患病率几乎相等。
