原发性乳糖酶缺乏是否会降低绝经后妇女的骨密度？系统评价和荟萃分析。

Does primary lactase deficiency reduce bone mineral density in postmenopausal women? A systematic review and meta-analysis.

机构信息

Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, 84105, Beer-Sheva, Israel.

Clalit Health Services, Southern District, Beer-Sheva, Israel.

出版信息

Osteoporos Int. 2018 Nov;29(11):2399-2407. doi: 10.1007/s00198-018-4635-1. Epub 2018 Jul 16.

DOI:10.1007/s00198-018-4635-1

PMID:30009335

Abstract

UNLABELLED

Postmenopausal osteoporosis is a significant cause of morbidity and mortality. The role of primary lactase deficiency (PLD) in its development is not clear. This meta-analysis showed that PLD is a risk factor for osteoporosis in postmenopausal women. These women need special attention in terms of screening for osteoporosis and its prevention.

INTRODUCTION

Postmenopausal osteoporosis is an important predictor of bone fractures. The purpose of the study was to conduct a systematic review and meta-analysis of association of PLD and bone mineral density (BMD) in postmenopausal women.

METHODS

The electronic databases PubMed, Scopus, and Web of Science were searched over the course of July 2017 for any date of publication without language limitation. Studies were included in the meta-analysis if the diagnosis of PLD was made by genetic testing or H-2 breath tests and the diagnosis of osteoporosis was made by a modern reliable method for BMD measurement. Two investigators conducted a comprehensive, independent review of all the papers. Five of the studies initially identified met the inclusion criteria. We used MOOSE guidelines for abstracting data and assessing data quality and validity. Meta-analysis was performed using the random effects model.

RESULTS

Five case-control studies with 2223 participants and 763 lactase-deficient cases fulfilled the inclusion criteria. Meta-analysis showed a significantly higher bone density Z-score in absorbers (mean difference 0.20, CI (0.14-0.27), P = 0.000), with no significant heterogeneity among the studies. Moreover, the Z-score in the vast majority of the measured sites (femoral head, femoral neck, lumbar spine, radius, and Ward's triangle) was significantly higher in absorbers. There was no significant overall difference in BMD in g/cm between absorbers and non-absorbers, but a significantly higher BMD using g/cm was observed in absorbers in the total hip site.

CONCLUSIONS

Postmenopausal women with PLD had lower Z-scores at most anatomic sites compared to healthy controls.

摘要

目的

绝经后骨质疏松症是导致发病率和死亡率的重要原因。原发性乳糖酶缺乏症（PLD）在其发病机制中的作用尚不清楚。本研究通过荟萃分析发现 PLD 是绝经后妇女骨质疏松症的危险因素。这些妇女在骨质疏松症筛查和预防方面需要特别关注。

背景

绝经后骨质疏松症是骨折的重要预测因素。本研究的目的是对 PLD 与绝经后妇女骨密度（BMD）的相关性进行系统评价和荟萃分析。

方法

检索 2017 年 7 月之前发表的、无语言限制的电子数据库 PubMed、Scopus 和 Web of Science，以获取任何日期的文献。如果通过基因检测或 H-2 呼气试验诊断为 PLD，且通过现代可靠的 BMD 测量方法诊断为骨质疏松症，则将这些研究纳入荟萃分析。两名研究者对所有论文进行了全面、独立的审查。最初确定的五项研究符合纳入标准。我们使用 MOOSE 指南提取数据，并评估数据质量和有效性。使用随机效应模型进行荟萃分析。

结果

五项病例对照研究共纳入 2223 名参与者和 763 例乳糖酶缺乏症患者，符合纳入标准。荟萃分析显示，吸收者的骨密度 Z 评分显著较高（平均差异 0.20，CI（0.14-0.27），P=0.000），且各研究之间无显著异质性。此外，在大多数测量部位（股骨头、股骨颈、腰椎、桡骨和 Ward 三角），吸收者的 Z 评分显著较高。吸收者与非吸收者的 BMD 以 g/cm 为单位无显著差异，但吸收者的总髋部 BMD 以 g/cm 为单位显著较高。