Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China.
Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, China.
Nutrition. 2022 Nov-Dec;103-104:111808. doi: 10.1016/j.nut.2022.111808. Epub 2022 Jul 22.
The aims of this study were to examine the association between osteoporotic vertebral compression refractures (OVCRFs) and visceral fat and to identify other risk factors for OVCRFs.
We included 311 patients with OVCRs who underwent percutaneous kyphoplasties (PKPs) at our hospital between May 2016 and December 2017. The visceral fat area (VFA) at the plane of the third lumbar vertebra was assessed using preoperative computed tomography (CT) scans. The patients were divided into two groups: OVCRFs and non-OVCRFs. The perioperative variables were compared between the two groups. Univariate and multivariate analyses were used to determine independent risk factors for OVCRFs. Correlation analysis was performed to investigate the association between bone mineral density (BMD) and visceral fat.
During the 1-y follow-up, 311 patients were included in the analysis. OVCRFs occurred in 69 patients (22.19%). High VFA was present in 163 patients (52.41%), including 52 OVCRFs and 111 non-OVCRF patients. In all the patients, high VFA (P < 0.001), older age (P = 0.022), female sex (P = 0.020), lower body mass index (BMI; P = 0.028), lower albumin levels (P < 0.001), lower hemoglobin levels (P = 0.045), lower BMD (P < 0.001), lower L3 skeletal muscle index (L3 SMI; P < 0.001), lower subcutaneous fat area (SFA; P = 0.003), higher VFA/SFA ratio (V/S ratio; P < 0.001), higher visceral fat area/muscle area (V/M) ratio (P < 0.001), and higher visceral fat index (VFI; P = 0.001) were associated with OVCRFs. Multivariate analysis revealed that patients of female sex (P < 0.001) and high VFA (P < 0.001) were independent risk predictors for OVCRFs. Higher BMD (P = 0.014) was a protective predictor of OVCRFs. Among all the overweight and obese patients (BMI ≥24 kg/m), high VFA(P = 0.002), female sex (P = 0.044), lower albumin levels (P = 0.003), lower hemoglobin levels (P = 0.010), lower vitamin D levels (P = 0.037), lower BMD (P < 0.001), lower L3 SMI (P = 0.015), higher V/S ratios (P = 0.003), higher V/M ratios (P < 0.001), and higher VFIs (P = 0.005) were associated with OVCRFs. Multivariate analysis revealed that higher VFAs (P = 0.004) remained an independent predictor of OVCRFs in overweight and obese patients. Higher BMD (P = 0.011) was a protective predictor of OVCRFs. In the correlation analysis, a negative correlation was observed between the BMD and both the visceral fat area and V/M ratio.
High VFA is a highly independent risk factor for OVCRFs. Other factors affecting OVCRFs include belonging to the female sex and low BMD. In overweight and obese patients, high VFA and low BMD are independent risk factors for OVCRFs.
本研究旨在探讨骨质疏松性椎体压缩性骨折（OVCRF）与内脏脂肪之间的关系，并确定 OVCRF 的其他危险因素。
我们纳入了 2016 年 5 月至 2017 年 12 月在我院接受经皮椎体后凸成形术（PKP）的 311 例 OVCRF 患者。使用术前计算机断层扫描（CT）评估第三腰椎平面的内脏脂肪面积（VFA）。将患者分为 OVCRF 组和非 OVCRF 组。比较两组患者的围手术期变量。采用单因素和多因素分析确定 OVCRF 的独立危险因素。采用相关分析研究骨密度（BMD）与内脏脂肪之间的关系。
在 1 年的随访中，对 311 例患者进行了分析。69 例患者（22.19%）发生 OVCRF。163 例患者存在高 VFA（52.41%），其中 52 例发生 OVCRF，111 例未发生 OVCRF。在所有患者中，高 VFA（P<0.001）、年龄较大（P=0.022）、女性（P=0.020）、较低的体重指数（BMI；P=0.028）、较低的白蛋白水平（P<0.001）、较低的血红蛋白水平（P=0.045）、较低的 BMD（P<0.001）、较低的第三腰椎骨骼肌指数（L3 SMI；P<0.001）、较低的皮下脂肪面积（SFA；P=0.003）、较高的 VFA/SFA 比值（V/S 比值；P<0.001）、较高的内脏脂肪面积/肌肉面积（V/M）比值（P<0.001）和较高的内脏脂肪指数（VFI；P=0.001）与 OVCRF 相关。多因素分析显示，女性（P<0.001）和高 VFA（P<0.001）是 OVCRF 的独立危险因素。较高的 BMD（P=0.014）是 OVCRF 的保护因素。在所有超重和肥胖患者（BMI≥24kg/m）中，高 VFA（P=0.002）、女性（P=0.044）、较低的白蛋白水平（P=0.003）、较低的血红蛋白水平（P=0.010）、较低的维生素 D 水平（P=0.037）、较低的 BMD（P<0.001）、较低的 L3 SMI（P=0.015）、较高的 V/S 比值（P=0.003）、较高的 V/M 比值（P<0.001）和较高的 VFI（P=0.005）与 OVCRF 相关。多因素分析显示，在超重和肥胖患者中，较高的 VFA（P=0.004）仍然是 OVCRF 的独立危险因素。较高的 BMD（P=0.011）是 OVCRF 的保护因素。在相关分析中，BMD 与内脏脂肪面积和 V/M 比值均呈负相关。
高 VFA 是 OVCRF 的高度独立危险因素。影响 OVCRF 的其他因素包括女性和较低的 BMD。在超重和肥胖患者中，高 VFA 和较低的 BMD 是 OVCRF 的独立危险因素。
