中老年人维生素D水平对骨质疏松的影响及相关性分析
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摘要
目的探讨中老年人维生素D水平对骨质疏松的影响及其相关性。方法选取2012年1月—12月行体检的中老年人80例,均行不同部位骨密度测定及维生素D水平检测。按照骨密度不同,分为骨质疏松组、骨量减少组及骨量正常组,而骨量减少组与骨量正常组又统称为非骨质疏松组。比较不同部位骨密度及维生素D表达水平,采用logistic分析探究维生素D与骨质疏松的相关性。结果本研究骨质疏松组19例,骨量减少组27例,骨量正常组34例。与骨质疏松组比较,骨量减少组、骨量正常组的腰2～腰3、股骨颈、大粗隆及Wards三角的骨密度升高,差异有统计学意义(P <0. 05)。骨质疏松组、骨量减少组、骨量正常组25羟维生素D水平分别为(53. 13±11. 71) mmol/L、(57. 24±12. 73) mmol/L、(57. 82±13. 53) mmol/L,比较差异无统计学意义(P> 0. 05)。骨质疏松组与非骨质疏松组性别、年龄、25羟维生素D及碱性磷酸酶水平比较差异有统计学意义(P <0. 05)。logistic回归分析显示,25羟维生素D及碱性磷酸酶水平、年龄与性别为骨质疏松的高危因素。结论临床可通过骨密度测定及时诊断骨质疏松,而骨密度降低与维生素D缺乏、年龄、碱性磷酸酶降低有关。
Objective To probe the effects of the vitamin D level on osteoporosis in the elderly and their correlation. Methods Eighty-eight middle-aged and elderly people who underwent physical examination in our hospital from January to December 2012 were selected for bone mineral density(BMD) measurement and vitamin D level testing in different parts of body. According to different levels of BMD,all these patients were divided into osteoporosis group,osteopenia group and normal BMD group. The osteopenia group and normal BMD group were collectively called non-osteoporosis group. The expression levels of vitamin D and BMD at different parts of body were compared and the correlation between vitamin D and osteoporosis were researched with logistic analysis. Results In this study,there were 19 patients in osteoporosis group,27 in osteopenia group and 34 in normal BMD group. Compared with the osteoporosis group,BMD of L2-3,femoral neck,large trochanter and Wards triangle was increased in osteopenia group and normal BMD group,and the difference was statistically significant(P < 0. 05). The levels of 25-hydroxyvitamin D in the osteoporosis group,the osteopenia group and the normal BMD group were(53. 13 ± 11. 71) mmol/L,(57. 24 ± 12. 73) mmol/L,and(57. 82 ± 13. 53) mmol/L,respectively. There was no statistically significant difference(P > 0. 05). Significant differences were found in sex,age,25-hydroxyvitamin D and alkaline phosphatase levels between the osteoporosis group and non-osteoporosis group(P < 0. 05). Logistic regression analysis showed that 25-hydroxyvitamin D,alkaline phosphatase(ALP) levels,age and gender were risk factors for osteoporosis.Conclusion Osteoporosis can be diagnosed in time by BMD measurement,and BMD reduction is associated with vitamin D deficiency,age,and ALP reduction.
Objective To probe the effects of the vitamin D level on osteoporosis in the elderly and their correlation. Methods Eighty-eight middle-aged and elderly people who underwent physical examination in our hospital from January to December 2012 were selected for bone mineral density(BMD) measurement and vitamin D level testing in different parts of body. According to different levels of BMD,all these patients were divided into osteoporosis group,osteopenia group and normal BMD group. The osteopenia group and normal BMD group were collectively called non-osteoporosis group. The expression levels of vitamin D and BMD at different parts of body were compared and the correlation between vitamin D and osteoporosis were researched with logistic analysis. Results In this study,there were 19 patients in osteoporosis group,27 in osteopenia group and 34 in normal BMD group. Compared with the osteoporosis group,BMD of L2-3,femoral neck,large trochanter and Wards triangle was increased in osteopenia group and normal BMD group,and the difference was statistically significant(P < 0. 05). The levels of 25-hydroxyvitamin D in the osteoporosis group,the osteopenia group and the normal BMD group were(53. 13 ± 11. 71) mmol/L,(57. 24 ± 12. 73) mmol/L,and(57. 82 ± 13. 53) mmol/L,respectively. There was no statistically significant difference(P > 0. 05). Significant differences were found in sex,age,25-hydroxyvitamin D and alkaline phosphatase levels between the osteoporosis group and non-osteoporosis group(P < 0. 05). Logistic regression analysis showed that 25-hydroxyvitamin D,alkaline phosphatase(ALP) levels,age and gender were risk factors for osteoporosis.Conclusion Osteoporosis can be diagnosed in time by BMD measurement,and BMD reduction is associated with vitamin D deficiency,age,and ALP reduction.
引文
[1]中华医学会骨质疏松和骨矿盐分会.原发性骨质疏松症诊疗指南(2017)[J].中国全科医学,2017,32(20):3963-3982.
[2]梁明.老年人维生素D水平与骨密度的关系[J].现代诊断与治疗,2013,24(7):1507-1508.
[3]王鸥,邢小平.老年性骨质疏松症发病机制及药物治疗进展[J].中国实用内科杂志,2011,31(8):584-586.
[4] Holick M F,Binkley N C,Bischoffferrari H A,et al. Evaluation,treatment,and prevention of vitamin D deficiency:an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab,2011,96(12):3908.
[5]彭岳文,刘芳,古振,等.岳阳地区50岁以上人群25羟维生素D水平及其与骨密度的关系[J].中国骨质疏松杂志,2013,19(7):686-690.
[6]赵凡,林吉生,费琦.男性骨质疏松症的治疗进展[J].中国临床医生,2014,42(2):14-16.
[7]孔璐,陈永军.骨质疏松症的病因与防治[J].临床荟萃,1999,14(6):284-285.
[8]余玲玲,陈治卿,陈健,等.钙剂和维生素D对骨密度的影响[J].中国临床营养杂志,2000,8(4):266-267.
[9]郭春英,黄妙清,薛延,等.老年骨质疏松患者服用钙加维生素D后骨密度及生化指标的改变[J].中国临床营养杂志,2000,8(3):205-207.
[10]刘国强,姜世平,徐谦.唑来膦酸联合钙尔奇D治疗原发性骨质疏松症的研究[J].临床军医杂志,2012,40(6):1359-1361.
[11]王滟,鲜同彰,牟忠卿.重视继发性骨质疏松症的病因诊断[J].临床误诊误治,2012,25(11):30-33.
[12]阳旭峰,阳定安.骨质疏松症的治疗进展[J].临床误诊误治,2007,20(10):42-43.
[13]姬尚丽,谢忠建.钙剂和维生素D在骨质疏松防治中的经典作用[J].药品评价,2013,10(5):27-30.
[14]谷晔红,段若芷.产后妇女与非孕健康妇女骨密度及骨代谢相关激素的研究[J].首都医科大学学报,2000,21(3):259-260.
[15]沈冬云.老年人维生素D3缺乏的临床分析[J].江苏医药,2010,36(23):2852.
[16]王衍.老年人莫忘补充维生素D[J].食品与健康,2012(4):22.
[17]周波,王晓红,王松涛,等.中国老年人骨量丢失与维生素D受体基因启动子中Cdx-2结合位点的多态性[J].中国组织工程研究与临床康复,2008,12(46):9130-9133.
[18] Steingrimsdottir L,Halldorsson T I,Siggeirsdottir K,et al. Hip fractures and bone mineral density in the elderly--Importance of serum 25-hydroxyvitamin D[J]. PLo S One,2014,9(3):e91122.
[19] Cipriani C,Pepe J,Piemonte S,et al. Vitamin d and its relationship with obesity and muscle[J]. Int J Endocrinol,2014,2014:841248.
[20] Rothenbacher D,Klenk J,Denkinger M D,et al.Prospective evaluation of renal function,serum vitamin D level,and risk of fall and fracture in community-dwelling elderly subjects[J]. Osteoporos Int,2014,25(3):923-932.
[21] Schlogl M,Holick M F. Vitamin D and neurocognitive function[J]. Clin Interv Aging,2014,9:559-568.
[22] Laughlin G A,Kritz-Silverstein D,Bergstrom J,et al. Vitamin D Insufficiency and Cognitive Function Trajectories in Older Adults:The Rancho Bernardo Study[J]. J Alzheimers Dis,2017,58(3):871-883.
[23]中华医学会骨质疏松和骨矿盐疾病分会.维生素D及其类似物临床应用共识[J].中华骨质疏松和骨矿盐疾病杂志,2018,11(1):20-25.
[24]麻凤清.老年人维生素D缺乏症的防治[J].中国实用医药,2010,5(11):139.
[25]孟宏霞,刘洁冰,张升红.绝经后骨质疏松症发病相关因素临床分析[J].武警医学院学报,2011,20(1):13-16.
[2]梁明.老年人维生素D水平与骨密度的关系[J].现代诊断与治疗,2013,24(7):1507-1508.
[3]王鸥,邢小平.老年性骨质疏松症发病机制及药物治疗进展[J].中国实用内科杂志,2011,31(8):584-586.
[4] Holick M F,Binkley N C,Bischoffferrari H A,et al. Evaluation,treatment,and prevention of vitamin D deficiency:an Endocrine Society clinical practice guideline[J]. J Clin Endocrinol Metab,2011,96(12):3908.
[5]彭岳文,刘芳,古振,等.岳阳地区50岁以上人群25羟维生素D水平及其与骨密度的关系[J].中国骨质疏松杂志,2013,19(7):686-690.
[6]赵凡,林吉生,费琦.男性骨质疏松症的治疗进展[J].中国临床医生,2014,42(2):14-16.
[7]孔璐,陈永军.骨质疏松症的病因与防治[J].临床荟萃,1999,14(6):284-285.
[8]余玲玲,陈治卿,陈健,等.钙剂和维生素D对骨密度的影响[J].中国临床营养杂志,2000,8(4):266-267.
[9]郭春英,黄妙清,薛延,等.老年骨质疏松患者服用钙加维生素D后骨密度及生化指标的改变[J].中国临床营养杂志,2000,8(3):205-207.
[10]刘国强,姜世平,徐谦.唑来膦酸联合钙尔奇D治疗原发性骨质疏松症的研究[J].临床军医杂志,2012,40(6):1359-1361.
[11]王滟,鲜同彰,牟忠卿.重视继发性骨质疏松症的病因诊断[J].临床误诊误治,2012,25(11):30-33.
[12]阳旭峰,阳定安.骨质疏松症的治疗进展[J].临床误诊误治,2007,20(10):42-43.
[13]姬尚丽,谢忠建.钙剂和维生素D在骨质疏松防治中的经典作用[J].药品评价,2013,10(5):27-30.
[14]谷晔红,段若芷.产后妇女与非孕健康妇女骨密度及骨代谢相关激素的研究[J].首都医科大学学报,2000,21(3):259-260.
[15]沈冬云.老年人维生素D3缺乏的临床分析[J].江苏医药,2010,36(23):2852.
[16]王衍.老年人莫忘补充维生素D[J].食品与健康,2012(4):22.
[17]周波,王晓红,王松涛,等.中国老年人骨量丢失与维生素D受体基因启动子中Cdx-2结合位点的多态性[J].中国组织工程研究与临床康复,2008,12(46):9130-9133.
[18] Steingrimsdottir L,Halldorsson T I,Siggeirsdottir K,et al. Hip fractures and bone mineral density in the elderly--Importance of serum 25-hydroxyvitamin D[J]. PLo S One,2014,9(3):e91122.
[19] Cipriani C,Pepe J,Piemonte S,et al. Vitamin d and its relationship with obesity and muscle[J]. Int J Endocrinol,2014,2014:841248.
[20] Rothenbacher D,Klenk J,Denkinger M D,et al.Prospective evaluation of renal function,serum vitamin D level,and risk of fall and fracture in community-dwelling elderly subjects[J]. Osteoporos Int,2014,25(3):923-932.
[21] Schlogl M,Holick M F. Vitamin D and neurocognitive function[J]. Clin Interv Aging,2014,9:559-568.
[22] Laughlin G A,Kritz-Silverstein D,Bergstrom J,et al. Vitamin D Insufficiency and Cognitive Function Trajectories in Older Adults:The Rancho Bernardo Study[J]. J Alzheimers Dis,2017,58(3):871-883.
[23]中华医学会骨质疏松和骨矿盐疾病分会.维生素D及其类似物临床应用共识[J].中华骨质疏松和骨矿盐疾病杂志,2018,11(1):20-25.
[24]麻凤清.老年人维生素D缺乏症的防治[J].中国实用医药,2010,5(11):139.
[25]孟宏霞,刘洁冰,张升红.绝经后骨质疏松症发病相关因素临床分析[J].武警医学院学报,2011,20(1):13-16.