Thiébaud D, Burckhardt P, Costanza M, Sloutskis D, Gilliard D, Quinodoz F, Jacquet A F, Burnand B
Department of Internal Medicine, University Hospital, Lausanne, Switzerland.
Osteoporos Int. 1997;7(5):457-62. doi: 10.1007/s001980050033.
The relative importance of vitamin D deficiency, secondary hyperparathyroidism, nutritional deficiency and low bone mineral density (BMD) as risk factors for hip fracture is not definitely established. In the framework of a case-control study of risk factors for hip fractures, biochemical markers of bone metabolism and nutrition and femoral BMD data were compared in 136 female and 43 male hip fracture patients, 136 female and 44 male age-matched hospitalized controls, and 47 healthy elderly women (8 men). Patients with hip fracture had lower albumin (-10%) and 25(OH)-vitamin D (25(OH)D; -19%) compared with hospitalized controls, and lower albumin (-28%) and 25(OH)D levels (-52%) compared with the elderly controls. Serum values of IGFBP-3 were also significantly lower (-33%) in hip fracture patients than in community controls. BMD of femoral neck was lower (p < 0.001) in patients than in hospitalized and community controls. In hip fracture patients, parathyroid hormone (PTH) correlated weakly with BMD (neck: r = -0.19, trochanter: r = -0.17; both p < 0.05). When all women were pooled (n = 233), albumin correlated significantly (age-adjusted) with BMD at all sites (neck: r = 0.27, trochanter: r = 0.25; all p < 0.001). Albumin, but not 25(OH)D, also correlated with skinfold thickness (r = 0.19, p < 0.0025) and with body mass index (BMI) (r = 0.14, p < 0.05). Male patients with hip fracture had lower BMD and albumin (both p < 0.001), 25(OH)D (p = 0.02) and IGFBP-3 levels (p < 0.005) compared with the controls. When male patients and controls were pooled together, albumin, skinfold thickness and BMI were significantly correlated with each other, but not with BMD. IGFBP-3 was highly correlated with albumin (p < 0.0001), 25(OH)D (p < 0.005) and, less significantly, with PTH (p < 0.05), but not with BMI or skinfold thickness. IGFBP-3 was significantly correlated with BMD at all sites (neck: r = 0.27, p < 0.05; trochanter: r = 0.40, p < 0.0005). In conclusion, low albumin and low BMD were both important risk factors for hip fracture. Low serum albumin was the strongest independent variable correlated with hip fractures. In men. IGFBP-3 was correlated with BMD. The femoral BMD depended only weakly on PTH and 25(OH)D, but was correlated at all sites with albumin, a non-specific parameter of nutrition and general health.
维生素D缺乏、继发性甲状旁腺功能亢进、营养缺乏和低骨矿物质密度（BMD）作为髋部骨折风险因素的相对重要性尚未明确确立。在一项关于髋部骨折风险因素的病例对照研究框架内，对136名女性和43名男性髋部骨折患者、136名年龄匹配的女性和44名男性住院对照以及47名健康老年女性（8名男性）的骨代谢和营养生化标志物以及股骨BMD数据进行了比较。与住院对照相比，髋部骨折患者的白蛋白（-10%）和25（OH）-维生素D（25（OH）D；-19%）较低，与老年对照相比，白蛋白（-28%）和25（OH）D水平（-52%）较低。髋部骨折患者的IGFBP-3血清值也显著低于社区对照（-33%）。患者的股骨颈BMD低于住院对照和社区对照（p < 0.001）。在髋部骨折患者中，甲状旁腺激素（PTH）与BMD的相关性较弱（颈部：r = -0.19，转子：r = -0.17；均p < 0.05）。当所有女性合并（n = 233）时，白蛋白与所有部位的BMD显著相关（年龄调整后）（颈部：r = 0.27，转子：r = 0.25；均p < 0.001）。白蛋白而非25（OH）D也与皮褶厚度（r = 0.19，p < 0.0025）和体重指数（BMI）（r = 0.14，p < 0.05）相关。与对照相比，男性髋部骨折患者的BMD和白蛋白（均p < 0.001）、25（OH）D（p = 0.02）和IGFBP-3水平（p < 0.005）较低。当男性患者和对照合并在一起时，白蛋白、皮褶厚度和BMI彼此显著相关，但与BMD无关。IGFBP-3与白蛋白（p < 0.0001）、25（OH）D（p < 0.005）高度相关，与PTH相关性较弱（p < 0.05），但与BMI或皮褶厚度无关。IGFBP-3与所有部位的BMD显著相关（颈部：r = 0.27，p < 0.05；转子：r = 0.40，p < 0.0005）。总之，低白蛋白和低BMD都是髋部骨折的重要风险因素。低血清白蛋白是与髋部骨折相关的最强独立变量。在男性中，IGFBP-3与BMD相关。股骨BMD仅微弱依赖于PTH和25（OH）D，但在所有部位均与白蛋白相关，白蛋白是营养和总体健康的非特异性参数。
