Pasco Julie A, Mohebbi Mohammadreza, Holloway Kara L, Brennan-Olsen Sharon L, Hyde Natalie K, Kotowicz Mark A
Deakin University, Geelong, Australia.
Melbourne Medical School-Western Campus, University of Melbourne, St Albans, Australia.
J Cachexia Sarcopenia Muscle. 2017 Jun;8(3):482-489. doi: 10.1002/jcsm.12177. Epub 2016 Dec 26.
We aimed to examine the relationship between musculoskeletal deterioration and all-cause mortality in a cohort of women studied prospectively over a decade.
A cohort of 750 women aged 50-94 years was followed for a decade after femoral neck bone mineral density (BMD) and appendicular lean mass (ALM) were measured using dual energy X-ray absorptiometry, in conjunction with comorbidities, health behaviour data, and other clinical measures. The outcome was all-cause mortality identified from the Australian National Deaths Index. Using Cox proportional hazards models and age as the time variable, mortality risks were estimated according to BMD groups (ideal-BMD, osteopenia, and osteoporosis) and ALM groups (T-scores > -1.0 high, -2.0 to -1.0 medium, <-2.0 low).
During 6712 person years of follow-up, there were 190 deaths, the proportions increasing with diminishing BMD: 10.7% (23/215) ideal-BMD, 23.5% (89/378) osteopenia, 49.7% (78/157) osteoporosis; and with diminishing ALM: 17.0% (59/345) high, 26.2% (79/301) medium, 50.0% (52/104) low. In multivariable models adjusted for smoking, polypharmacy, and mobility, compared with those with ideal BMD, mortality risk was greater for those with osteopenia [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.11-2.81] and osteoporosis (HR 2.61, 95%CI 1.60-4.24). Similarly, compared with those with high ALM, adjusted mortality risk was greater for medium ALM (HR 1.36, 95%CI 0.97-1.91) and low ALM (HR 1.65, 95%CI 1.11-2.45). When BMD and ALM groups were tested together in the model, BMD remained a predictor of mortality (HR 1.74, 95%CI 1.09-2.78; HR 2.82, 95%CI 1.70-4.70; respectively), and low ALM had borderline significance (HR 1.52, 95%CI 1.00-2.31), which was further attenuated after adjusting for smoking, polypharmacy, and mobility.
Poor musculoskeletal health increased the risk for mortality independent of age. This appears to be driven mainly by a decline in bone mass. Low lean mass independently exacerbated mortality risk, and this appeared to operate through poor health exposures.
我们旨在研究一组女性在十年前瞻性研究中肌肉骨骼退化与全因死亡率之间的关系。
对750名年龄在50 - 94岁的女性进行队列研究，使用双能X线吸收法测量股骨颈骨密度（BMD）和四肢瘦体重（ALM），并收集合并症、健康行为数据及其他临床指标，随访十年。结局指标为通过澳大利亚国家死亡指数确定的全因死亡率。使用Cox比例风险模型，以年龄作为时间变量，根据BMD分组（理想骨密度、骨量减少、骨质疏松）和ALM分组（T值＞ -1.0为高、-2.0至-1.0为中、＜ -2.0为低）估计死亡风险。
在6712人年的随访期间，有190例死亡，死亡比例随BMD降低而增加：理想骨密度组为10.7%（23/215），骨量减少组为23.5%（89/378），骨质疏松组为49.7%（78/157）；随ALM降低也增加：高ALM组为17.0%（59/345），中ALM组为26.2%（79/301），低ALM组为50.0%（52/104）。在调整吸烟、多种药物治疗和活动能力的多变量模型中，与理想BMD者相比，骨量减少者的死亡风险更高[风险比（HR）1.77，95%置信区间（CI）1.11 - 2.81]，骨质疏松者更高（HR 2.61，95%CI 1.60 - 4.24）。同样，与高ALM者相比，中ALM者的调整后死亡风险更高（HR 1.36，95%CI 0.97 - 1.91），低ALM者更高（HR 1.65，95%CI 1.11 - 2.45）。当在模型中同时检验BMD和ALM分组时，BMD仍然是死亡率的预测指标（HR分别为1.74，95%CI 1.09 - 2.78；HR 2.82，95%CI 1.70 - 4.70），低ALM具有临界显著性（HR 1.52，95%CI 1.00 - 2.31），在调整吸烟、多种药物治疗和活动能力后进一步减弱。
肌肉骨骼健康状况不佳会增加与年龄无关的死亡风险。这似乎主要由骨量下降所致。低瘦体重独立加剧死亡风险，且这似乎是通过不良健康暴露起作用。
