骨折老年男性的皮质骨孔隙率增加。
Increased Cortical Porosity in Older Men With Fracture.
作者信息
Sundh Daniel, Mellström Dan, Nilsson Martin, Karlsson Magnus, Ohlsson Claes, Lorentzon Mattias
机构信息
Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
出版信息
J Bone Miner Res. 2015 Sep;30(9):1692-700. doi: 10.1002/jbmr.2509. Epub 2015 May 21.
Cortical porosity increases with age and affects bone strength, but its association with fracture in older men is unknown. The aim of this study was to investigate whether cortical porosity is associated with prevalent fractures in older men. A subsample of 456 men aged 80.2 ± 3.5 (mean ± SD) years, with available high-resolution peripheral quantitative computed tomography measurements at the tibia from the 5-year follow-up exam, was drawn from the prospective MrOS Gothenburg study. Dual-energy X-ray absorptiometry was used to measure areal bone mineral density (aBMD). Data on physical activity, calcium intake, medications, diseases, and smoking were collected on questionnaires at the follow-up exam. Of 87 men (19.1%) with fracture at or after age 50 years (all fracture group), 52 (11.4%) had had a self-reported fracture before the baseline exam and 35 (7.7%) had had an X-ray-verified fracture between baseline and follow-up. Men in the all-fracture group and in the X-ray-verified group had 15.8% (13.2% ± 4.9% versus 11.4% ± 3.8%; p < 0.001) and 21.6% (14.1% ± 5.2% versus 11.6% ± 3.9%; p < 0.01) higher cortical porosity, respectively, than men in the nonfracture group. The independent associations between bone microstructure parameters and fracture were tested using multivariate logistic regression with age, height, weight, calcium intake, smoking, physical activity, medications, and diseases as covariates. Cortical porosity was independently associated with any fracture (reported or X-ray-verified; OR per SD increase 1.49; 95% confidence interval (CI), 1.17 to 1.90) and with any X-ray-verified fracture alone (OR 1.73; 95% CI, 1.23 to 2.42). Including aBMD (spine or hip, respectively) in the multivariate logistic regression above revealed that cortical porosity was associated with any fracture (OR 1.54; 95% CI, 1.17 to 2.01) and with X-ray-verified fracture alone (OR 1.49; 95% CI, 1.00 to 2.22). Cortical porosity was associated with prevalence of fracture even after adjustment for aBMD.
皮质骨孔隙率随年龄增长而增加，并影响骨强度，但在老年男性中其与骨折的关联尚不清楚。本研究的目的是调查皮质骨孔隙率是否与老年男性的既往骨折有关。从前瞻性的哥德堡MrOS研究中抽取了一个456名男性的子样本，他们的年龄为80.2±3.5（均值±标准差）岁，在5年随访检查中有可用的胫骨高分辨率外周定量计算机断层扫描测量数据。使用双能X线吸收法测量骨面积密度（aBMD）。在随访检查时通过问卷收集了关于身体活动、钙摄入量、药物、疾病和吸烟的数据。在87名50岁及以后发生骨折的男性（所有骨折组）中，52名（11.4%）在基线检查前有自我报告的骨折，35名（7.7%）在基线和随访之间有X线证实的骨折。所有骨折组和X线证实组的男性皮质骨孔隙率分别比无骨折组的男性高15.8%（13.2%±4.9%对11.4%±3.8%；p<0.001）和21.6%（14.1%±5.2%对11.6%±3.9%；p<0.01）。使用多因素逻辑回归，以年龄、身高、体重、钙摄入量、吸烟、身体活动、药物和疾病作为协变量，测试骨微结构参数与骨折之间的独立关联。皮质骨孔隙率与任何骨折（报告的或X线证实的；每标准差增加的比值比为1.49；95%置信区间（CI），1.17至1.90）以及单独与任何X线证实的骨折独立相关（比值比为1.73；95%CI，1.23至2.42）。在上述多因素逻辑回归中纳入aBMD（分别为脊柱或髋部）显示，皮质骨孔隙率与任何骨折（比值比为1.54；95%CI，1.17至2.01）以及单独与X线证实的骨折相关（比值比为1.49；95%CI，1.00至2.22）。即使在调整aBMD后，皮质骨孔隙率仍与骨折患病率相关。
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