骨质疏松症(OP)常见于老年群体,易引发脆性骨折。高骨转换型OP的骨形成和骨吸收过程均表现为活跃,治疗困难,缺乏有效改善骨密度(BMD)的治疗方式。以高骨转换型OP患者为研究对象,通过治疗前的康复评定和随访研究,旨在寻找其预后的独立性影响因素。指标包括:BMD、血清铁蛋白水平、下肢肌力的站起-坐下测试(CRT)时间、Berg平衡功能量表(BBS)评分等。结果显示,血清铁蛋白每增加1个单位,发生脆性骨折的风险增加5.3%,CRT每延长1 s,发生脆性骨折的风险增加4.12倍,患者的铁蛋白水平越高,CRT越长,则预后的BMD越低,而BBS每增加1分,发生脆性骨折的风险减少15.8%。说明铁储存水平、下肢肌力和平衡能力是影响高骨转换型OP预后的独立性因素。
Osteoporosis (OP) is common in the elderly population and can easily lead to brittle fractures. The bone formation and bone resorption processes of high bone turnover OP are both active, making treatment difficult and lacking effective treatment methods to improve bone density (BMD). This study focuses on patients with high bone turnover type OP and aims to identify independent prognostic factors through rehabilitation assessment and follow-up studies before treatment. The indicators include BMD, serum ferritin level, standing sit test (CRT) time for lower limb muscle strength, Berg balance function scale (BBS) score, etc. The results show that for every 1 unit increase in serum ferritin, the risk of brittle fracture is increased by 5.3%. For every 1 second extension of CRT, the risk of brittle fracture is increased by 4.12 times. The higher the patient's ferritin level and the longer the CRT, the lower the prognosis of BMD. However, for every 1 point increase in BBS, the risk of brittle fracture is decreased by 15.8%. The iron storage level, lower limb muscle strength, and balance ability are mutually independent factors that affect the prognosis of high bone turnover type OP.
[1] 中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2017)[J]. 中华骨质疏松和骨矿盐疾病杂志, 2017, 10(5): 413-443.
[2] Qadir A, Liang S, Wu Z, et al. Senile osteoporosis: The involvement of differentiation and senescence of bone mar⁃row stromal cells[J]. International Journal of Molecular Sciences, 2020, 21(1): 349.
[3] 陈良慈 . 核心稳定训练对骨质疏松症患者平衡功能、下肢肌力及跌倒发生的影响[J]. 临床研究, 2019, 27(3): 15-17.
[4] Compston J E, McClung M R, Leslie W D. Osteoporosis[J]. Lancet, 2019, 393(10169): 364-376.
[5] Wang L, Yu W, Yin X, et al. Prevalence of osteoporosis and fracture in China: The China osteoporosis prevalence study[J]. JAMA Netw Open, 2021, 4(8): e2121106.
[6] 贺丽英, 孙蕴, 要文娟, 等. 2010—2016年中国老年人骨质疏松症患病率Meta分析[J]. 中国骨质疏松杂志 , 2016, 22(12): 1590-1596.
[7] 翁玉蓉, 朱燕飞 . 绝经后骨质疏松症患者血清 IL-6、骨钙素 N 端中分子、骨碱性磷酸酶、雌二醇及 IGF-1 水平的变化及意义[J]. 中国妇幼保健, 2017, 32(12): 2672-2674.
[8] 张晟肇, 苏娜, 徐珽, 等. 地舒单抗用于经双膦酸盐治疗绝经后骨质疏松症的 Meta 分析[J]. 医药导报, 2020, 39(12): 1677-1683.
[9] 张辉, 徐又佳 . 铁调素与骨质疏松症[J]. 中华骨质疏松和骨矿盐疾病杂志, 2017, 10(2): 160-164.
[10] 赵昱, 张亚宁, 王彬, 等 . 影响老年女性骨质疏松症的危险因素调查及预防措施研究[J]. 系统医学, 2022, 7(24): 63-66.
[11] 段蔚楠, 易开君, 周高晋, 等 . 废用性骨质疏松症模型大鼠血清I型前胶原N端前肽分析研究[J]. 西北国防医学杂志, 2018, 39(12): 778-782.
[12] 胡小刚, 王红祥, 王巧娥, 等 . tP1NP、OCN和 β-CTX在骨质疏松性骨折和骨关节炎老年患者唑来膦酸治疗前后变化[J]. 临床和实验医学杂志, 2018, 17(12): 1299-1302.
[13] Hagins M, Lamberg E M. Individuals with low back pain breathe differently than healthy individuals during a lifting task[J]. Journal of Orthopaedic & Sports Physical Therapy, 2016, 46(3): 141-148.
[14] 杨雅琴, 周亚楠, 邢德利, 等 . Berg 平衡量表应用于帕金森病患者的信度分析[J]. 中国康复理论与实践, 2016, 22(3): 303-305.
[15] Lane N E. Epidemiology, etiology, and diagnosis of osteoporosis[J]. American Journal of Obstetrics & Gynecology, 2006, 194(Suppl 2): S3-S11.
[16] 彭红发, 闫晓楠 . 绝经激素治疗与骨质疏松症[J]. 中国实用妇科与产科杂志, 2020, 36(3): 230-233.
[17] 周颖昊, 孟醒 . 血清铁调素、PINP、β-CTX 在围绝经期骨质疏松症患者中的检测意义[J]. 中国医学工程, 2021, 29(3): 12-14.
[18] 张文韬, 陈勋, 宋涛, 等 . 血清铁过载与老年女性骨质疏松性骨折的相关性[J]. 海南医学, 2018, 29(24): 45-47.
[19] 廖强, 王娟. 骨质疏松患者血清25(OH)D,骨膜素、铁蛋白水平及其与骨折发生的相关性分析[J]. 现代检验医学杂志, 2021, 36(5): 138-142.
[20] 白璧辉, 谢兴文, 李鼎鹏, 等. 我国近5年来骨质疏松症流行病学研究现状[J]. 中国骨质疏松杂志, 2018, 24(2): 253-258.
[21] Chien M Y, Wu Y T, Hsu A T, et al. Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women[J]. Calcified Tissue International, 2000, 67(6): 443-448.
[22] Yeh J K, Aloia J F, Tierney J M, et al. Effect of treadmill exercise on vertebral and tibial bone mineral content and bone mineral density in the aged adult rat: Determined by dual energy X-ray absorptiometry[J]. Calcified Tissue International, 1993, 52(3): 234-238.
[23] Howe T E, Shea B, Dawson L J, et al. Exercise for preventing and treating osteoporosis in postmenopausal women[J]. Cochrane Database of Systematic Reviews, 2011, (7): CD000333.
[24] Pagnotti G M, Styner M, Uzer G, et al. Combating osteoporosis and obesity with exercise: Leveraging cell mechanosensitivity[J]. Nature Reviews Endocrinology, 2019, 15(6): 339-355.
[25] 顾文钦, 胡健康, 周鹏, 等 . 腰背部核心肌力训练对骨质疏松症患者平衡功能及骨密度的干预效果[J]. 中国临床医学, 2021, 28(5): 842-845.
[26] 吴青, 朱汉民. 骨质疏松基础防治措施对老年人25-羟基维生素 D 水平和下肢肌力及平衡功能的影响[J]. 中华老年医学杂志, 2014, 33(10): 1135-1138.