骨密度与脆性骨折风险的关系：中国长沙的病例对照研究。
Relationship between bone mineral density and fragility fracture risk: a case-control study in Changsha, China.
机构信息
National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, Hunan Provincial Key Laboratory for Metabolic Bone Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, 410011, Changsha, Hunan, PR China.
Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, 730000, Lanzhou, Gansu Province, PR China.
出版信息
BMC Musculoskelet Disord. 2021 Aug 24;22(1):728. doi: 10.1186/s12891-021-04616-8.
BACKGROUND
Fragility fracture is associated with bone mineral density (BMD), and most databases used in related researches are instrument-matched. Little is known about the relationship between BMD and fragility fracture risk of native Chinese, especially using local databases as reference databases.
OBJECTIVE
To investigate relationship between BMD and risk of fragility fracture in native China.
METHODS
3,324 cases, including 2,423 women (67.7 ± 8.9 years) and 901 men (68.4 ± 11.6 years) having radiological fragility fractures and 3,324 age- and gender-matched controls participated in the study. We measured BMD at posteroanterior spine and hip using dual-energy X-ray absorptiometry (DXA), calculated BMD measurement parameters based on our own BMD reference database.
RESULTS
BMDs and mean T-scores were lower in case group (with clinical fragility) than in control group (without clinical fragility). In patients with fragility fractures, prevalence of lumbar osteoporosis, low bone mass, and normal BMD were 78.9 %, 19.3 %, and 1.8 %, respectively, in women, and 49.5, 44.8 %, and 5.7 %, respectively, in men. In hip, these prevalence rates were 67.2 %, 28.4 %, and 4.4 % in females, and 43.2 %, 45.9 %, and 10.9 % in males, respectively, showing differences between females and males. Multivariate Cox regression analysis showed that after adjusting age, height, weight, and body mass index, fracture hazard ratio (HR) increased by 2.7-2.8 times (95 % CI 2.5-3.1) and 3.6-4.1 times (95 %CI 3.0-5.1) for women and men respectively with decreasing BMD parameters. In both sexes, risk of fragility fracture increased approximately 1.6-1.7 times (95 % CI 1.5-1.8) for every 1 T-score reduction in BMD.
CONCLUSIONS
Risk of clinical fragility fracture increases with decreasing BMD measurement parameters and anthropometric indicators in native China, and fracture HR varies from gender and site.
背景
脆性骨折与骨密度（BMD）有关，大多数相关研究中使用的数据库都是仪器匹配的。关于中国人的 BMD 与脆性骨折风险的关系知之甚少，尤其是使用当地数据库作为参考数据库。
目的
探讨中国人群 BMD 与脆性骨折风险的关系。
方法
3324 例患者（2423 例女性，67.7±8.9 岁；901 例男性，68.4±11.6 岁）均发生影像学脆性骨折，纳入病例组，另选取同期年龄和性别相匹配的 3324 例无临床脆性骨折患者作为对照组。采用双能 X 线吸收法（DXA）检测患者的前后位脊柱和髋部的 BMD，并基于我们自己的 BMD 参考数据库计算 BMD 测量参数。
结果
病例组（有临床脆性骨折）的 BMD 值和平均 T 评分均低于对照组（无临床脆性骨折）。脆性骨折患者中，女性腰椎骨质疏松、低骨量和正常 BMD 的患病率分别为 78.9%、19.3%和 1.8%，男性分别为 49.5%、44.8%和 5.7%。在髋部，女性的这些患病率分别为 67.2%、28.4%和 4.4%，男性分别为 43.2%、45.9%和 10.9%，女性和男性之间存在差异。多变量 Cox 回归分析显示，在调整年龄、身高、体重和体重指数后，女性和男性的骨折风险比（HR）分别增加 2.7-2.8 倍（95%CI 2.5-3.1）和 3.6-4.1 倍（95%CI 3.0-5.1），BMD 参数降低。在两性中，BMD 每降低 1 T 评分，脆性骨折的风险分别增加约 1.6-1.7 倍（95%CI 1.5-1.8）。
结论
在中国人群中，BMD 测量参数和人体测量指标的降低与临床脆性骨折风险的增加相关，骨折 HR 因性别和部位而异。
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