肾结石、骨密度、骨质疏松症与骨折：一项系统评价和比较性荟萃分析
Nephrolithiasis, bone mineral density, osteoporosis, and fractures: a systematic review and comparative meta-analysis.
作者信息
Lucato P, Trevisan C, Stubbs B, Zanforlini B M, Solmi M, Luchini C, Girotti G, Pizzato S, Manzato E, Sergi G, Giannini S, Fusaro M, Veronese N
机构信息
Department of Medicine - DIMED, Geriatrics Division, University of Padova, Via Giustiniani, 2, 35128, Padova, Italy.
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
出版信息
Osteoporos Int. 2016 Nov;27(11):3155-3164. doi: 10.1007/s00198-016-3658-8. Epub 2016 Jun 11.
UNLABELLED
Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures.
INTRODUCTION
People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs).
METHODS
Two investigators searched major databases for articles reporting BMD (expressed as g/cm or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated.
RESULTS
From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD = -0.69; 95 % CI = -0.86 to -0.52; I = 0 %), total hip (seven studies; SMD = -0.82; 95 % CI = -1.11 to -0.52; I = 72 %), and femoral neck (six studies; SMD = -0.67; 95 % CI = --1.00 to -0.34; I = 69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR = 1.15, 95 % CI = 1.12-1.17, p < 0.0001, studies = 4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR = 1.31, 95 % CI = 0.95-1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR = 4.12, p < 0.0001).
CONCLUSIONS
Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated.
未标注
我们的荟萃分析表明，肾结石患者骨矿物质密度降低，骨质疏松症几率增加，骨折风险可能升高。
引言
肾结石患者可能存在骨矿物质密度（BMD）降低和骨折风险，但数据并不明确。我们进行了一项荟萃分析，以调查肾结石患者与健康对照者（HCs）相比，是否有更差的骨骼健康结果（BMD）、骨质疏松症和骨折情况。
方法
两名研究人员在主要数据库中搜索报告肾结石患者样本和HCs的BMD（以g/cm或T值或Z值表示）、骨质疏松症或骨折情况的文章。计算BMD参数的标准化平均差（SMD）和95%置信区间（CI）；此外，计算病例对照研究的比值比（OR）以及纵向研究中分类变量的调整风险比（HR）。
结果
从1816条初始记录中，纳入了28项研究。对包括1595例肾结石患者（平均年龄41.1岁）和3402例HCs（平均年龄40.2岁）的病例对照研究进行了荟萃分析。肾结石患者脊柱的T值显著更低（7项研究；SMD = -0.69；95% CI = -0.86至-0.52；I² = 0%），全髋部（7项研究；SMD = -0.82；95% CI = -1.11至-0.52；I² = 72%），以及股骨颈（6项研究；SMD = -0.67；95% CI = -1.00至-0.34；I² = 69%）。病例对照研究的荟萃分析表明，肾结石患者骨折风险增加（OR = 1.15，95% CI = 1.12 - 1.17，p < 0.0001，研究 = 4项），而两项纵向研究中的骨折风险显示出趋势水平的显著性（HR = 1.31，95% CI = 0.95 - 1.62）。肾结石患者患骨质疏松症的可能性是HCs的四倍（OR = 4.12，p < 0.0001）。
结论
肾结石与较低的BMD、骨质疏松症风险增加以及可能的骨折有关。未来可能需要针对骨骼健康的筛查/预防性干预措施。
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