JBMR:在男性骨质疏松性骨折(MrOs)研究中,肌少症是独立于FRAX®、Falls和BMD的骨折风险预测因子

2021-09-29 从医路漫漫 MedSci原创

双能X线骨密度仪(DXA)得出的四肢骨骼肌瘦体重/身高2(ALM/HT2)是评估骨质疏松症时最常用的肌肉质量估计方式,但其对骨折的预测价值因股骨颈(FN)骨密度(BMD)而大大减弱。

背景:双能X线骨密度仪(DXA)得出的四肢骨骼肌瘦体重/身高2(ALM/HT2)是评估骨质疏松症时最常用的肌肉质量估计方式,但其对骨折的预测价值因股骨颈(FN)骨密度(BMD)而大大减弱。

方法:我们在美国、瑞典和香港男性骨质疏松性骨折研究(MROS)队列中,使用Poisson回归的扩展方法,独立于fnBMD、骨折风险评估工具(FRAX®)概率和既往跌倒因素,研究了11种肌少症对意外骨折的预测价值。肌少症的定义包括Baumgartner和Delmonico(仅ALM/HT2)、Morley、国际骨骼肌减少症工作组、欧洲老年人骨骼肌减少症工作组(EWGSOP1和2)、亚洲骨骼肌减少症工作组、国家卫生研究院基金会(FNIH) 1和2(使用ALM/身体质量指数[BMI]、结合肌肉力量和/或身体表现测量加上ALM/ht2)和肌少症定义和结果联盟(步态速度和握力)。根据基线的年龄和时间调整相关性,并报告首次骨折的危险比(HR),这里是主要骨质疏松性骨折(MOF;临床椎体、髋关节、前臂远端、肱骨近端)。进一步分析对FRAX-MOF概率(n=7531;计算的fnBMD)、先前跌倒(y/n)或fnBMD T评分进行了额外调整。结果由meta分析合成。

结果:在美国的5660名男性、瑞典的2764名男性和1987年香港的2764名男性(平均年龄分别为73.5岁、75.4岁和72.4岁)中,肌少症的患病率从0.5%至35%不等。肌肉减少状态,除FNIH外,都与MOF事件相关(HR = 1.39 - 2.07)。与先前跌倒或FRAX概率的调整(无fnBMD)相关,对fnBMDT评分的调整减弱了相关性。EWGSOP2重度骨骼肌减少症(包括椅立时间、步态速度、握力和ALM)是最具预测性的,尽管患病率较低,而且似乎只受到fnBMD的轻微影响。

表1 肌少症定义与偶发骨折的关系

图 骨质疏松症定义(IWGS、EWGSOP2“确认”、AWGS和SDOC)与发生重大骨质疏松性骨折的风险之间的关系。显示的数据是危险率(肌少症是/否)和95%置信区间的点估计值。提出的模型仅根据年龄和随访时间进行调整,然后另外根据既往跌倒、FRAX重大骨质疏松性骨折(MOF)概率无骨密度(BMD)、有BMD的FRAX MOF概率或股骨颈BMDT评分进行调整。

表2 EWGSOP2确认的主要骨质疏松性骨折事件的危险比(Y/N),按年龄段、肌少症×年龄交互作用的P值

结论:基于ALM的骨质疏松定义对骨折的预测价值因fnBMD的调整而降低,但通过额外纳入体能指标而增强。

原文出处

Harvey NC,  Orwoll E,  Kwok T,et al,Sarcopenia Definitions as Predictors of Fracture Risk Independent of FRAX , Falls, and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A Meta-Analysis.J Bone Miner Res 2021 Jul;36(7)

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    2021-10-01 膀胱癌
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    2021-10-01 lsndxfj
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    2021-10-01 Eleven17
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