Trinh Anne, Wong Phillip, Sakthivel Anuradha, Fahey Michael C, Hennel Sabine, Brown Justin, Strauss Boyd J, Ebeling Peter R, Fuller Peter J, Milat Frances
Department of Endocrinology, Monash Health, Melbourne, Victoria 3168, Australia.
Hudson Institute of Medical Research, Clayton, Melbourne, Victoria 3168, Australia.
J Endocr Soc. 2017 Sep 27;1(10):1301-1311. doi: 10.1210/js.2017-00258. eCollection 2017 Oct 1.
Spina bifida (SB) can lead to changes in body composition and bone mineral density (BMD) through diminished ambulation, renal impairment, and anticonvulsant medication. With increased life expectancy, diseases such as obesity and osteoporosis are emerging comorbidities in SB, with limited data to guide management.
To examine the relationship between cardiometabolic factors, body composition, BMD, and minimal trauma fractures (MTFs) in adults with SB.
Retrospective cross-sectional study.
Forty-nine adults with SB (median age, 32.7 years; interquartile range, 22.6 to 39.0) who had undergone dual-energy x-ray absorptiometry imaging at a single tertiary hospital from 2004 to 2015.
The mean body mass index was 31.7 ± 7.5 kg/m2; 26 (53.1%) were obese. Using age- and sex-matched fat percentiles from the National Health and Nutrition Examination Survey III, 62.5% had a total body percentage fat greater than the 95th percentile. Low bone mass (defined as a Z-score of ≤-2.0) was present in 21.9% at the L1 vertebra and in 35.1% at the femoral neck. Ten (20.4%) had a history of MTFs. A BMD or Z-score at L1, femoral neck, or total body site did not correlate with the occurrence of MTF. Fat mass was significantly and positively associated with BMD after adjustment for age, sex, and height and accounted for 18.6% of the variance in BMD ( = 0.005). The prevalence of metabolic comorbidities, such as hypertension (20.4%) and obstructive sleep apnea (16.3%), was high.
Obesity and low BMD are common in young adults with SB. An increased fat mass correlated significantly with BMD. The prevalence of metabolic complications in patients with SB is increased and deserves further study.
脊柱裂（SB）可通过活动减少、肾功能损害和抗惊厥药物治疗导致身体成分和骨矿物质密度（BMD）发生变化。随着预期寿命的延长，肥胖和骨质疏松等疾病在脊柱裂患者中成为越来越常见的合并症，而指导治疗的数据有限。
研究成年脊柱裂患者心脏代谢因素、身体成分、骨密度和轻微创伤性骨折（MTF）之间的关系。
回顾性横断面研究。
49例脊柱裂成年患者（中位年龄32.7岁；四分位间距22.6至39.0岁），于2004年至2015年在一家三级医院接受了双能X线吸收法成像检查。
平均体重指数为31.7±7.5kg/m²；26例（53.1%）为肥胖患者。根据第三次全国健康和营养检查调查的年龄和性别匹配脂肪百分位数，62.5%的患者全身脂肪百分比高于第95百分位数。L1椎体低骨量（定义为Z值≤-2.0）的发生率为21.9%，股骨颈为35.1%。10例（20.4%）有轻微创伤性骨折病史。L1、股骨颈或全身部位的骨密度或Z值与轻微创伤性骨折的发生无关。在调整年龄、性别和身高后，脂肪量与骨密度呈显著正相关，占骨密度方差的18.6%（P=0.005）。代谢合并症的患病率较高，如高血压（20.4%）和阻塞性睡眠呼吸暂停（16.3%）。
肥胖和低骨密度在年轻脊柱裂患者中很常见。脂肪量增加与骨密度显著相关。脊柱裂患者代谢并发症的患病率增加，值得进一步研究。
