INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
Division of Endocrinology, Diabetes, and Bone Diseases, TU Dresden Medical Center, Dresden, Germany.
J Bone Miner Res. 2017 Nov;32(11):2288-2296. doi: 10.1002/jbmr.3213. Epub 2017 Aug 7.
Fragility fractures and cardiovascular diseases often coincide. However, data on shared risk factors and markers are scarce. Our aim was to assess the independent associations of serum osteoprotegerin (OPG) levels with the risk of fracture and cardiovascular outcomes (acute coronary syndrome, cardiac death) in older men. A cohort of 819 home-dwelling men aged 60 to 87 years was followed prospectively for 8 years. Serum OPG was measured at baseline by ELISA. Bone mineral density (BMD) at femoral neck and Trabecular Bone Score (TBS) were assessed by DXA. Clinical risk factors and Fracture Risk Assessment Tool (FRAX) were assessed. The incident events (self-reported peripheral fractures and acute coronary syndrome, cardiac death reported by a proxy) confirmed by a health professional were retained for the statistical analysis. Incident vertebral fractures were assessed on lateral DXA scans after 4 and 8 years. Hazard risk (HR) was assessed using the Cox model. After adjustment for FRAX corrected for femoral neck BMD and TBS, diabetes mellitus, ischemic heart disease, and prior falls, the risk of fracture was twofold higher in the highest versus the lowest OPG quartile (HR 2.35; 95% CI, 1.35 to 4.10). The risk of vertebral and nonvertebral fracture was higher in the highest versus the lowest OPG quartile (OR 2.76 [95% CI, 1.08 to 7.05] and HR 2.46 [95% CI, 1.23 to 4.92]). The risk of major osteoporotic fracture was higher in the fourth versus the first OPG quartile (HR 2.43; 95% CI, 1.16 to 5.10). The risk of cardiovascular outcome (adjusted for confounders) was higher in the highest versus the lowest OPG quartile (HR 3.93; 95% CI, 1.54 to 10.04). The risk of fracture and cardiovascular outcome was higher in the highest OPG quartile versus the lower quartiles combined (HR 2.06 [95% CI, 1.35 to 3.14] and HR 2.98 [95% CI, 1.60 to 5.54], respectively). In conclusion, in older men, higher serum OPG levels represent an independent risk factor for cardiovascular and fracture risk. © 2017 American Society for Bone and Mineral Research.
骨脆性骨折和心血管疾病常同时发生。然而，关于共同危险因素和标志物的数据却很少。我们的目的是评估血清护骨素（OPG）水平与老年男性骨折风险和心血管结局（急性冠状动脉综合征、心脏性死亡）的独立相关性。一项前瞻性队列研究纳入了 819 名居住在社区的年龄在 60 岁至 87 岁之间的男性，随访时间为 8 年。采用酶联免疫吸附试验（ELISA）法在基线时测量血清 OPG。采用双能 X 线吸收法（DXA）评估股骨颈骨密度（BMD）和骨小梁评分（TBS）。评估临床危险因素和骨折风险评估工具（FRAX）。通过健康专业人员确认的报告的外周骨折和急性冠状动脉综合征的首发事件（通过代理报告的心脏性死亡）保留用于统计分析。在 4 年和 8 年后，通过侧位 DXA 扫描评估新发的椎体骨折。使用 Cox 模型评估危险风险（HR）。在校正股骨颈 BMD 和 TBS 后的 FRAX 校正后，与最低四分位 OPG 相比，最高四分位 OPG 发生骨折的风险增加了两倍（HR 2.35；95%CI，1.35 至 4.10）。与最低四分位 OPG 相比，最高四分位 OPG 发生椎体和非椎体骨折的风险更高（OR 2.76 [95%CI，1.08 至 7.05]和 HR 2.46 [95%CI，1.23 至 4.92]）。与第一四分位 OPG 相比，第四四分位 OPG 发生主要骨质疏松性骨折的风险更高（HR 2.43；95%CI，1.16 至 5.10）。与最低四分位 OPG 相比，最高四分位 OPG 的心血管结局（校正混杂因素后）风险更高（HR 3.93；95%CI，1.54 至 10.04）。与最低四分位 OPG 相比，最高四分位 OPG 的骨折和心血管结局风险更高（HR 2.06 [95%CI，1.35 至 3.14]和 HR 2.98 [95%CI，1.60 至 5.54]）。总之，在老年男性中，较高的血清 OPG 水平是心血管和骨折风险的独立危险因素。
