DXA 估计的全身去脂体重减少而非脂肪量与 FRAX 独立预测重大骨质疏松性骨折和髋部骨折：基于登记的队列研究。
Loss in DXA-estimated total body lean mass but not fat mass predicts incident major osteoporotic fracture and hip fracture independently from FRAX: a registry-based cohort study.
机构信息
Rady Faculty of Health Sciences, University of Manitoba, C5121-409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
Park Nicollet Clinic & HealthPartners Institute, Saint Louis Park, Minneapolis, MN, USA.
出版信息
Arch Osteoporos. 2020 Jun 25;15(1):96. doi: 10.1007/s11657-020-00773-w.
UNLABELLED
During median follow-up 6.0 years in 9622 individuals, prior loss in estimated total body lean mass (TBLM), but not total body fat mass loss (TBFM), was associated with increased fracture risk, particularly for hip fracture.
INTRODUCTION
Weight loss, and especially muscle loss, adversely affects skeletal health. The FRAX® tool considers baseline body mass index, but not body composition nor changes in its components over time. Our aim was to compare the independent associations between prior loss in DXA-estimated TBLM and TBFM and subsequent fracture risk.
METHODS
We identified women and men age 40 years or older with two DXA assessments at least 1 year apart (median interval 3.3 years). TBLM and TBFM were estimated from weight, sex, and DXA of the spine and hip. Incident fractures and deaths were ascertained from linked population-based health service data after the date of the second DXA. Hazard ratios (HRs) from Cox regression models were used to study time to fracture from prior loss in TBLM and TBFM adjusted for FRAX-related covariates.
RESULTS
The study population consisted of 9622 individuals (mean age 67 [SD 10] years, 95% female). We identified 692 subjects with incident major osteoporotic fracture [MOF] and 194 with hip fracture. Mean TBLM loss was significantly greater in those with incident MOF and hip fracture (P < 0.001) while TBFM loss was only significantly greater in those with incident hip fracture (P < 0.001). Each SD greater TBLM loss was associated with 10-13% increased MOF risk and 29-38% increased hip fracture risk, adjusted for TBFM loss and other covariates. Prior TBFM loss was not associated with fractures when adjusted for TBLM loss.
CONCLUSIONS
Prior loss in total body lean mass, but not in fat mass, is associated with increased fracture risk, particularly hip fracture, independent of other risk factors. This is consistent with the hypothesis that muscle loss (sarcopenia) adversely impacts skeletal health and fracture risk.
未标记
在 9622 名个体的中位随访 6.0 年中，先前的估计总体瘦体重（TBLM）损失，但不是总体体脂量损失（TBFM），与骨折风险增加相关，特别是髋部骨折。
引言
体重减轻，特别是肌肉减少，对骨骼健康不利。FRAX®工具考虑了基线体重指数，但不考虑身体成分，也不考虑其随时间的变化。我们的目的是比较 DXA 估计的 TBLM 和 TBFM 先前损失与随后骨折风险之间的独立关联。
方法
我们确定了年龄在 40 岁或以上、两次 DXA 评估至少相隔 1 年（中位数间隔 3.3 年）的女性和男性。TBLM 和 TBFM 是根据体重、性别以及脊柱和臀部的 DXA 来估计的。从第二次 DXA 日期后的关联人群健康服务数据中确定了骨折和死亡事件。使用 Cox 回归模型的风险比（HRs）来研究 TBLM 和 TBFM 先前损失与 FRAX 相关协变量调整后的骨折时间。
结果
研究人群由 9622 人组成（平均年龄 67[SD 10]岁，95%为女性）。我们确定了 692 名发生主要骨质疏松性骨折[MOF]的受试者和 194 名髋部骨折的受试者。在发生 MOF 和髋部骨折的患者中，TBLM 损失的平均值明显更大（P<0.001），而仅在发生髋部骨折的患者中，TBFM 损失明显更大（P<0.001）。TBLM 损失每增加一个标准差，MOF 风险增加 10-13%，髋部骨折风险增加 29-38%，调整 TBFM 损失和其他协变量后。当调整 TBLM 损失时，先前的 TBFM 损失与骨折无关。
结论
总体瘦体重的损失，而不是脂肪量的损失，与骨折风险增加相关，特别是髋部骨折，与其他危险因素无关。这与肌肉减少（肌少症）对骨骼健康和骨折风险产生不利影响的假设一致。
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