Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
BMC Womens Health. 2022 Nov 21;22(1):465. doi: 10.1186/s12905-022-02034-z.
As postmenopausal osteoporotic fractures can cause higher rates of disability and mortality in women; it is essential to analyze the factors associated with primary and recurrent fractures in postmenopausal osteoporosis (PMOP) patients.
Retrospective analysis of 2478 PMOP patients aged ≥ 50 years who attended the Shanghai General Hospital from January 2007 to December 2016, including 1239 patients with no fractures and 1239 patients with histories of fractures (1008 in the primary fracture group and 231 in the re-fracture group). All patients' basic clinical data, serum biochemical and bone metabolic markers, bone mineral density (BMD), and other indicators were recorded uniformly. Comparing the differences between the clinical characteristics of patients with primary and recurrent fractures, as well as the differences in the clinical characteristics of patients with primary and recurrent fractures in combination with different diseases, further analyses the risk factors for primary and recurrent fractures in PMOP patients. SPSS.26 was used for statistical analysis.
Compared to the unfractured group, the fractured group was older and had lower height and bone mineral density (all P < 0.01), with the re-fractured group having lower BMD at each key site than the primary fracture group (all P < 0.01). Analysis of the combined disease subgroups showed that serum BGP levels were lower in the primary and re-fracture patients with diabetes than in the non-diabetic subgroup (P < 0.05), and serum CTX levels were lower in the re-fracture group with diabetes than in the primary fracture group with diabetes (P < 0.05). Patients with recurrent fractures with cardio-vascular diseases had lower BMD than the subgroup without cardio-vascular diseases (P < 0.05) and also had lower BMD than the group with primary fractures with cardio-vascular diseases (P < 0.05). Multiple logistic regression analysis showed that advanced age, overweight, low lumbar spine and total hip BMD were risk factors for primary and recurrent fractures; and comorbid chronic liver and kidney diseases were risk factors for primary fractures.
PMOP patients with advanced age, overweight, low bone mineral density, and comorbid chronic liver and kidney diseases are at greater risk of fractures and require early intervention to reduce fractures occurrence. Moreover, those who are elderly, overweight, and have low bone density should also be aware of the risk of re-fractures.
绝经后骨质疏松性骨折会导致女性更高的残疾率和死亡率；因此，分析绝经后骨质疏松症（PMOP）患者初次和复发性骨折相关因素至关重要。
回顾性分析 2007 年 1 月至 2016 年 12 月在上海长征医院就诊的 2478 例年龄≥50 岁的 PMOP 患者，包括无骨折的 1239 例患者和有骨折史的 1239 例患者（初次骨折组 1008 例，再骨折组 231 例）。所有患者的基本临床资料、血清生化和骨代谢标志物、骨密度（BMD）等指标均进行统一记录。比较初次和复发性骨折患者的临床特征差异，以及初次和复发性骨折患者结合不同疾病的临床特征差异，进一步分析 PMOP 患者初次和复发性骨折的危险因素。采用 SPSS.26 进行统计分析。
与无骨折组相比，骨折组年龄较大，身高和骨密度较低（均 P<0.01），且再骨折组各关键部位的 BMD 均低于初次骨折组（均 P<0.01）。结合疾病亚组分析发现，糖尿病合并初次和再骨折患者的血清 BGP 水平低于非糖尿病亚组（P<0.05），糖尿病合并再骨折患者的血清 CTX 水平低于糖尿病合并初次骨折患者（P<0.05）。心血管疾病合并复发性骨折患者的 BMD 低于无心血管疾病亚组（P<0.05），也低于心血管疾病合并初次骨折患者（P<0.05）。多因素 logistic 回归分析显示，高龄、超重、腰椎和全髋 BMD 较低是初次和复发性骨折的危险因素；合并慢性肝肾疾病是初次骨折的危险因素。
PMOP 患者中年龄较大、超重、骨密度较低以及合并慢性肝肾疾病的患者发生骨折的风险更高，需要早期干预以降低骨折发生风险。此外，高龄、超重和骨密度较低的患者也应注意再骨折的风险。
