肥胖与50岁以上男性骨质疏松的相关性研究

目的 利用不同人体测量指标，调查分析成都地区50岁以上男性居民中肥胖与骨质疏松的相关性。方法 采集在四川大学华西医院进行健康体检的50岁以上男性受检者的临床资料，并测量和计算不同人体测量参数。使用MetriScan手掌骨密度测量仪进行骨密度测定，并根据T值将受试者分为3组（正常骨密度组、骨量减少组和骨质疏松组），比较各组间肥胖的检出率。将体质量指数（BMI）、体圆柱指数（BRI）、腰围、腰高比（WHtR）、腰臀比（WHR）、身体形态指数（ABSI）和身高等人体测量参数分别按四分位数等分为Q1、Q2、Q3、Q4四组，均以Q1组为参照组，采用单因素及年龄矫正后的多元logistic回归分析上述人体测量参数与骨质疏松检出风险的关系。同时计算各指标受试者操作特征（ROC）曲线的曲线下面积（AUC）。结果 共纳入9 135例成都地区50岁以上男性居民，其中骨质疏松症的检出率为5.75%（525例）。骨质疏松组各种人体测量参数（BMI、WHR、WHtR、体质量、腰围、臀围、ABSI、BRI等）与骨量减少组和正常骨密度组比较差异具有统计学意义（ P<0.01）。与最低四分位数（Q1）组相比，BMI、BRI、WHtR、WHR、ABSI、腰围和身高的最高四分位数（Q4）组受检者合并骨质疏松的经年龄矫正的比值比分别为0.443〔95%可信区间（ CI）：0.342～0.574〕、0.580（95% CI：0.454～0.740）、0.587（95% CI：0.460～0.751）、0.664（95% CI：0.516～0.854）、1.369（95% CI：1.069～1.751）、0.634（95% CI：0.497～0.809）、1.357（95% CI：1.047～1.758）。ROC曲线分析显示，BMI对骨质疏松的AUC为0.606（95% CI：0.580~0.632）。结论 肥胖与男性骨质疏松呈一定的负相关，利用BMI测量的肥胖对男性骨质疏松有潜在的预测价值，需要进一步的纵向研究明确其临床意义。
Objective To investigate the association between obesity and osteoporosis in men aged above 50 in Chengdu. Methods Male participants aged above 50 were recruited from those who visited West China Hospital of Sichuan University for health examinations. Bone mineral density was measured by MetriScan Bone Densitometry. The participants were divided into three groups according to T values: normal, osteopenia and osteoporosis. Results About 5.75% (525 cases) of the 9 135 male participants had osteoporosis. The three groups had significant different anthropometric parameters, including body mass, waist circumference, hip circumference, body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), a body shape index (ABSI), and body roundness index (BRI)( P<0.01). The participants with the highest quartile (Q4) of BMI, BRI, WHtR, WHR, ABSI, waist circumference and height had an age-adjusted odds ratios (OR) of 0.443 〔95% confidence interval ( CI): 0.342-0.574), 0.580 (95% CI: 0.454-0.740), 0.587 (95% CI: 0.460-0.751), 0.664 (95% CI: 0.516-0.854〕, 1.369 (95% CI: 1.069-1.751), 0.634 (95% CI: 0.497-0.809), and 1.357 (95% CI: 1.047-1.758), respectively, for osteoporosis compared with those with the lowest quartile (Q1). The area under cures (AUC) of receiver operator characteristic (ROC) curve of BMI for osteoporosis was 0.606 (95% CI：0.580-0.632). Conclusion Large body mass was negatively associated with osteoporosis in middle and old aged men. BMI is the strongest predictor of osteoporosis. Further longitudinal studies are required to verify such asscoiations.