Zhang Xiaowen, Man Kwong-Wai, Li Gloria Hoi-Yee, Tan Kathryn Cb, Kung Annie Wai-Chee, Cheung Ching-Lung
Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong.
Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University.
EClinicalMedicine. 2022 Jun 8;49:101488. doi: 10.1016/j.eclinm.2022.101488. eCollection 2022 Jul.
Accumulating evidence suggests the interaction of bone metabolism and the immune system, but how bone health is associated with the risk of infections remains unknown.
This study aimed to investigate the relationship of bone mineral density (BMD) with the risk of common infections and sepsis in Hong Kong Osteoporosis Study (HKOS). A prospective cohort study, initiated in 1995 and followed until 31 December 2020, of 5,717 participants examined the association of BMD at three skeletal sites (lumbar spine, femoral neck, and total hip) with common infections - pneumonia, urinary tract infection (UTI), skin infection, and sepsis. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).
During the median follow-up of 17 years, higher BMD T-scores at the femoral neck and total hip were significantly associated with the reduced risk of pneumonia (HRs 0.89 and 0.87; 95% CIs 0.82 to 0.98 and 0.81 to 0.95), UTI (HRs 0.85 and 0.86; 95% CIs 0.76 to 0.94 and 0.78 to 0.95), skin infection (HRs 0.85 and 0.82; 95% CIs 0.74 to 0.97 and 0.73 to 0.93), and sepsis (HRs 0.83 and 0.82; 95% CIs 0.71 to 0.97 and 0.72 to 0.94). A significant association was observed for the lumbar spine BMD T-score with the risk of skin infection (HR 0.86; 95% CI: 0.78 to 0.95) but not with other infections and sepsis. Similarly, participants with osteoporosis, but not osteopenia, were significantly associated with an increased risk of infections and sepsis compared to those with normal BMD.
BMD is a novel risk factor of infections and sepsis. People with low BMD, particularly those with osteoporosis, are at higher risk of infections and sepsis than those with normal BMD. Further studies on whether improving bone health can reduce the risk of infections and sepsis are warranted.
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越来越多的证据表明骨代谢与免疫系统之间存在相互作用，但骨骼健康与感染风险之间的关联尚不清楚。
本研究旨在调查香港骨质疏松症研究（HKOS）中骨密度（BMD）与常见感染及脓毒症风险之间的关系。一项前瞻性队列研究于1995年启动，随访至2020年12月31日，对5717名参与者进行了研究，考察了三个骨骼部位（腰椎、股骨颈和全髋）的骨密度与常见感染（肺炎、尿路感染（UTI）、皮肤感染）及脓毒症之间的关联。采用Cox比例风险模型来估计风险比（HR）和95%置信区间（CI）。
在17年的中位随访期内，股骨颈和全髋较高的骨密度T值与肺炎风险降低显著相关（HR分别为0.89和0.87；95%CI分别为0.82至0.98和0.81至0.95）、UTI（HR分别为0.85和0.86；95%CI分别为0.76至0.94和0.78至0.95）、皮肤感染（HR分别为0.85和0.82；95%CI分别为0.74至0.97和0.73至0.93）以及脓毒症（HR分别为0.83和0.82；95%CI分别为0.71至0.97和0.72至0.94）。观察到腰椎骨密度T值与皮肤感染风险存在显著关联（HR为0.86；95%CI：0.78至0.95），但与其他感染及脓毒症无关。同样，与骨密度正常者相比，骨质疏松患者（而非骨量减少患者）感染及脓毒症风险显著增加。
骨密度是感染和脓毒症的一个新的风险因素。骨密度低的人，尤其是骨质疏松患者，比骨密度正常者感染和脓毒症风险更高。有必要进一步研究改善骨骼健康是否能降低感染和脓毒症风险。
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