不同 1 型胶原 C 末端肽水平的骨质疏松性骨折绝经后妇女骨密度与骨代谢标志物的相关性：一项回顾性分析研究。

Correlation between bone mineral density and bone metabolic markers in postmenopausal women with osteoporotic fractures at different C-terminal telopeptide of type 1 collagen levels: a retrospective analysis study.

机构信息

From the Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Menopause. 2023 Nov 1;30(11):1139-1146. doi: 10.1097/GME.0000000000002257. Epub 2023 Oct 18.

DOI:10.1097/GME.0000000000002257

PMID:37847873

Abstract

OBJECTIVE

This study aimed to analyze the correlation between bone mineral density (BMD) and bone resorption markers in postmenopausal women with osteoporosis fractures and identify risk factors for second fractures.

METHODS

This retrospective analysis of 1,239 older women with fractures with a median age of 70 years who attended Shanghai General Hospital from January 2007 to December 2016, included a first fracture group (1,008 cases) and a second fractures group (231 cases). The risk factors for fractures were analyzed by comparing these groups on clinical characteristics, BMD, and bone metabolism markers stratified by quartiles of serum C-terminal telopeptide of type 1 collagen (CTX). Binary logistic regression analysis was used to identify risk factors for second fractures.

RESULTS

In the whole sample, BMD was negatively correlated with age and serum osteocalcin and positively correlated with body mass index (BMI). In women with first fractures, those in the highest quartile of serum CTX had the lowest spine and hip BMD. Second fractures were significantly associated with BMI, lower spine and hip BMD, and higher serum osteocalcin but not CTX. Binary logistic regression analysis showed that high BMI (odds ratio [OR], 1.08 [95% CI, 1.03-1.14]; P = 0.001), low lumbar BMD (OR, 0.24 [95% CI, 0.07-0.82]; P = 0.023), low total hip BMD (OR, 0.05 [95% CI, 0.00-0.88]; P = 0.041), and lack of antiosteoporosis treatment (OR, 2.71 [95% CI, 2.71-4.08]; P < 0.001) were independent risk factors for second fractures.

CONCLUSIONS

In older women with fractures, BMD was significantly lower in women with second fractures than in those with first fractures. Higher levels of serum CTX and osteocalcin, which indicates increased bone resorption, were negatively correlated with BMD. In women with a first fracture, serum CTX higher than 605 pg/mL was negatively correlated with BMD, whereas no correlation was found between different CTX and BMD in women with second fractures. High BMI and low BMD as well as not receiving antiosteoporosis treatment were independent risk factors for second fractures.

摘要

目的

本研究旨在分析绝经后骨质疏松性骨折患者的骨密度（BMD）与骨吸收标志物之间的相关性，并确定再次骨折的危险因素。

方法

这是一项回顾性分析，纳入了 2007 年 1 月至 2016 年 12 月在上海总医院就诊的 1239 名年龄中位数为 70 岁的老年骨折患者，包括首次骨折组（1008 例）和再次骨折组（231 例）。通过比较两组的临床特征、BMD 和按血清 1 型胶原 C 端肽（CTX）的四分位间距分层的骨代谢标志物，分析骨折的危险因素。采用二元逻辑回归分析确定再次骨折的危险因素。

结果

在整个样本中，BMD 与年龄和血清骨钙素呈负相关，与体重指数（BMI）呈正相关。在首次骨折的女性中，CTX 血清最高四分位数的脊柱和髋部 BMD 最低。再次骨折与 BMI、较低的脊柱和髋部 BMD、较高的血清骨钙素相关，但与 CTX 无关。二元逻辑回归分析显示，高 BMI（比值比 [OR]，1.08 [95%置信区间，1.03-1.14]；P = 0.001）、较低的腰椎 BMD（OR，0.24 [95%置信区间，0.07-0.82]；P = 0.023）、全髋 BMD 较低（OR，0.05 [95%置信区间，0.00-0.88]；P = 0.041）和未接受抗骨质疏松治疗（OR，2.71 [95%置信区间，2.71-4.08]；P < 0.001）是再次骨折的独立危险因素。

结论

在骨折的老年女性中，再次骨折的女性 BMD 明显低于首次骨折的女性。表明骨吸收增加的血清 CTX 和骨钙素水平较高与 BMD 呈负相关。在首次骨折的女性中，CTX 血清水平高于 605pg/ml 与 BMD 呈负相关，而在再次骨折的女性中，CTX 与 BMD 之间无相关性。高 BMI 和低 BMD 以及未接受抗骨质疏松治疗是再次骨折的独立危险因素。