胃切除术后 20 年或以上的社区居住老年男性骨质疏松性骨折风险增加：藤原-京骨质疏松风险男性（FORMEN）队列研究。

Increased risk of osteoporotic fracture in community-dwelling elderly men 20 or more years after gastrectomy: The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study.

机构信息

Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan.

出版信息

Bone. 2019 Oct;127:250-259. doi: 10.1016/j.bone.2019.06.014. Epub 2019 Jun 26.

DOI:10.1016/j.bone.2019.06.014

PMID:31254731

Abstract

PURPOSE

Many studies have reported that patients with a history of gastrectomy (gastrectomized patients) have lower areal bone mineral density (aBMD) and higher fracture risk than those without. However, population-based studies on this topic are scarce, and little is known regarding the bone metabolic status of gastrectomized patients in the long-term. This study aimed to clarify the association of gastrectomy with aBMD, bone metabolism markers, and fracture risk in community-dwelling elderly Japanese men.

METHODS

A total of 1992 men aged ≥65 years completed baseline measurements including aBMD at the spine and hip, serum levels of intact parathyroid hormone (PTH), intact osteocalcin (OC), tartrate-resistant acid phosphatase isoenzyme 5b (TRACP5b), and undercarboxylated OC (ucOC), and an interview regarding past medical history including gastrectomy. Osteoporotic fractures (OPFs) that occurred during the 5-year follow-up period were determined through structured interviews.

RESULTS

After excluding participants with type 1 diabetes mellitus and those with missing values, 1985 men, including 132 gastrectomized men, were analyzed. Gastrectomized men had significantly higher PTH, TRACP5b, and ucOC levels, and lower aBMD, than non-gastrectomized men. Gastrectomy was associated with a significantly higher risk of OPF after adjusting for confounding variables (hazard ratio (HR): 2.55, 95% confidence interval (CI): 1.17, 5.55), and the risk was no longer significant when further adjusted for PTH and aBMD. Even in this model, however, increase in OPF risk was significant in gastrectomized men who survived 20 years or more after the surgery (HR: 3.56, 95% CI: 1.33, 9.52).

CONCLUSIONS

History of gastrectomy was associated with elevated bone resorption, decreased aBMD, and increased fracture risk in community-dwelling elderly Japanese men. This increase in fracture risk was more prominent long after gastrectomy.

摘要

目的

许多研究报告称，胃切除术（胃切除术后）患者的面积骨密度（aBMD）低于没有胃切除术的患者，骨折风险更高。然而，关于这个主题的基于人群的研究很少，对于胃切除术后患者的长期骨代谢状态知之甚少。本研究旨在阐明胃切除术与社区居住的日本老年男性的 aBMD、骨代谢标志物和骨折风险之间的关系。

方法

共有 1992 名年龄≥65 岁的男性完成了基线测量，包括脊柱和髋部的 aBMD、血清完整甲状旁腺激素（PTH）、完整骨钙素（OC）、抗酒石酸酸性磷酸酶 5b（TRACP5b）和未羧化 OC（ucOC）水平，以及关于既往病史的访谈，包括胃切除术。在 5 年随访期间通过结构化访谈确定骨质疏松性骨折（OPF）的发生情况。

结果

排除 1 型糖尿病患者和缺失值患者后，共分析了 1985 名男性，其中包括 132 名胃切除术后患者。与非胃切除术后患者相比，胃切除术后患者的 PTH、TRACP5b 和 ucOC 水平明显较高，aBMD 明显较低。调整混杂变量后，胃切除术与 OPF 的风险显著增加（风险比（HR）：2.55，95%置信区间（CI）：1.17，5.55），进一步调整 PTH 和 aBMD 后，风险不再显著。然而，即使在该模型中，胃切除术患者在手术后 20 年或更长时间存活时，OPF 风险增加仍然显著（HR：3.56，95%CI：1.33，9.52）。