Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
Bone. 2020 Aug;137:115404. doi: 10.1016/j.bone.2020.115404. Epub 2020 Apr 30.
Although associations among obesity, adipocytokines, and bone mineral density have been reported, the influence of adipocytokines on osteoporotic fractures remains unclear. This study aimed to assess the impact of the adipocytokines leptin and adiponectin on the risk of incident vertebral and long-bone fractures in postmenopausal women. Clinical data were obtained from the retrospective Nagano Cohort Study of outpatients followed at a single primary care institute in Nagano Prefecture, Japan, between 1993 and 2018. The primary outcome was the occurrence of incident vertebral or long-bone fractures. In total, 1167 Japanese postmenopausal women (mean age: 65.9 years) completed the follow-up and the average observation period was 7.2 years. The subjects were divided into 4 groups (quartile 1 to 4) based respective leptin and adiponectin values. Kaplan-Meier analysis demonstrated a significantly lower incident long-bone fracture rate in the higher quartiles of serum leptin levels (p = 0.002). A significantly higher and more rapid occurrence of incident vertebral fractures, but not long-bone fractures, was found in the highest adiponectin quartile (p < 0.001). A Cox proportional hazards model adjusted for confounders including age, body weight, and either leptin or adiponectin revealed lower leptin levels and higher adiponectin levels as significant independent risk factors for incident long-bone fractures (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.50-0.96; p = 0.03) and vertebral fractures (HR 1.18, 95% CI 1.02-1.37; p = 0.02), respectively. Therefore, serum leptin and adiponectin may be independent risk factors for osteoporotic fractures affecting different bone types and sites. Determining patient adipocytokine levels may help predict the occurrence of specific osteoporotic fractures, thereby enabling optimal treatment for osteoporosis and improving quality of life.
虽然已经报道了肥胖、脂肪细胞因子和骨密度之间的关联，但脂肪细胞因子对骨质疏松性骨折的影响仍不清楚。本研究旨在评估脂肪细胞因子瘦素和脂联素对绝经后妇女发生椎骨和长骨骨折风险的影响。临床数据来自于日本长野县一家初级保健机构的回顾性长野队列研究，该研究于 1993 年至 2018 年期间对门诊患者进行随访。主要结局是发生椎骨或长骨骨折。共有 1167 名日本绝经后妇女（平均年龄：65.9 岁）完成了随访，平均观察期为 7.2 年。根据各自的瘦素和脂联素值，将受试者分为 4 组（四分位 1 至 4 组）。Kaplan-Meier 分析显示，血清瘦素水平较高的四分位组发生长骨骨折的发生率显著降低（p = 0.002）。在脂联素最高四分位组中，发现椎骨骨折的发生率更高且发生速度更快，但长骨骨折则不然（p < 0.001）。多因素 Cox 比例风险模型调整了年龄、体重和瘦素或脂联素等混杂因素后，发现较低的瘦素水平和较高的脂联素水平是发生长骨骨折（风险比 [HR] 0.70，95%置信区间 [CI] 0.50-0.96；p = 0.03）和椎骨骨折（HR 1.18，95% CI 1.02-1.37；p = 0.02）的独立危险因素。因此，血清瘦素和脂联素可能是影响不同骨骼类型和部位的骨质疏松性骨折的独立危险因素。确定患者的脂肪细胞因子水平可能有助于预测特定骨质疏松性骨折的发生，从而为骨质疏松症提供最佳治疗并提高生活质量。
