Department of Aged Care and Rehabilitation, Nepean Hospital, Penrith, NSW, Australia; Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia.
Research Group on Geriatrics and Gerontology, Faculty of Health Sciences, International Association of Gerontology and Geriatrics Collaborative Centre, Universidad de Caldas, Manizales, Colombia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia.
Maturitas. 2018 Jul;113:21-25. doi: 10.1016/j.maturitas.2018.04.006. Epub 2018 Apr 18.
The combination of osteopenia/osteoporosis and sarcopenia (osteosarcopenia) defines a diagnostic subset of individuals at higher risk of falls, fractures and institutionalization. In this study we aimed to assess the potential role of high serum levels of parathyroid hormone (PTH) in osteosarcopenia. We hypothesized that a high PTH level is one of the major determinants of this syndrome.
Cross-sectional study in 400 subjects (mean age = 79, 65% women) assessed between 2009 and 2014 at the Falls and Fractures Clinic, Nepean Hospital (Penrith, Australia).
Medical history, physical examination, bone densitometry, body composition, posturography, grip strength, gait parameters, and blood tests for nutrition and secondary causes of sarcopenia and osteoporosis. Patients were assigned to one of four groups: 1) osteopenic/osteoporotic; 2) sarcopenic; 3) osteosarcopenic; or 4) non-sarcopenic/non-osteopenic. Patients with abnormal corrected calcium levels were excluded from analysis. Between-group differences were assessed using one-way analysis of variance and chi-squared tests. Multivariable linear regression was used to evaluate the association between the groups and PTH levels adjusted for age, vitamin D, renal function and albumin.
24% of the subjects had a high serum PTH level with normal corrected calcium level. These subjects were older, reported more falls per year, and had lower grip strength, limits of stability, BMD, and gait velocity. Subjects with high PTH levels were more likely to be in the osteosarcopenia group than in the non-sarcopenic/non-osteopenic group (OR 6.88; CI: 1.9-9.2).
We reported an independent association between high PTH levels and osteosarcopenia. Our results suggest an important role of PTH in osteosarcopenia that deserves further exploration.
骨质疏松/骨量减少症和肌少症（骨肌减少症）的组合定义了一个具有更高跌倒、骨折和住院风险的亚组人群。本研究旨在评估甲状旁腺激素（PTH）血清水平升高在骨肌减少症中的潜在作用。我们假设高 PTH 水平是该综合征的主要决定因素之一。
这是一项 2009 年至 2014 年期间在澳大利亚彭里斯的内平医院（Nepean Hospital）跌倒和骨折诊所进行的 400 例（平均年龄 79 岁，65%为女性）受试者的横断面研究。
病史、体格检查、骨密度测定、身体成分、姿势描记术、握力、步态参数以及营养和肌少症及骨质疏松症继发原因的血液检查。患者被分为以下四组之一：1）骨质疏松/骨量减少组；2）肌少症组；3）骨肌减少症组；或 4）非肌少症/非骨质疏松症组。异常校正钙水平的患者被排除在分析之外。使用单因素方差分析和卡方检验评估组间差异。多变量线性回归用于评估在调整年龄、维生素 D、肾功能和白蛋白后，各组与 PTH 水平之间的关联。
24%的受试者血清 PTH 水平升高且校正钙水平正常。这些患者年龄较大，每年跌倒次数较多，握力、稳定性极限、BMD 和步态速度较低。与非肌少症/非骨质疏松症组相比，高 PTH 水平的患者更有可能处于骨肌减少症组（比值比 6.88；95%置信区间：1.9-9.2）。
我们报告了高 PTH 水平与骨肌减少症之间的独立关联。我们的结果表明 PTH 在骨肌减少症中具有重要作用，值得进一步研究。
