切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (04) : 435 -439. doi: 10.3877/cma.j.issn.1674-134X.2020.04.008

所属专题： 骨科学； 文献；

临床论著

股骨颈骨折合并抑郁老年男性骨密度和骨代谢变化
刘驰1, 石磊2, 何婧3, 刘军川2, 赵懋宇2, 张耀南2, 薛庆云1,†()   
  1. 1. 100730　北京医院骨科，国家老年医学中心；100005　北京协和医学院研究生院
    2. 100730　北京医院骨科，国家老年医学中心
    3. 100730　北京医院神经内科，国家老年医学中心
  • 收稿日期:2020-04-20 出版日期:2020-08-01
  • 通信作者: 薛庆云

Bone mineral density and bone metabolism in elderly males with femoral neck fractures and depression

Chi Liu1, Lei Shi2, Jing He3, Junchuan Liu2, Maoyu Zhao2, Yaonan Zhang2, Qingyun Xue1,†()   

  1. 1. Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing l00730, China; Graduate School of Peking Union Medical College, Beijing 100005, China
    2. Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Beijing l00730, China
    3. Department of Neurology, Beijing Hospital, National Center of Gerontology, Beijing l00730, China
  • Received:2020-04-20 Published:2020-08-01
  • Corresponding author: Qingyun Xue
  • About author:
    Corresponding author: Xue Qingyun, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

刘驰, 石磊, 何婧, 刘军川, 赵懋宇, 张耀南, 薛庆云. 股骨颈骨折合并抑郁老年男性骨密度和骨代谢变化[J]. 中华关节外科杂志(电子版), 2020, 14(04): 435-439.

Chi Liu, Lei Shi, Jing He, Junchuan Liu, Maoyu Zhao, Yaonan Zhang, Qingyun Xue. Bone mineral density and bone metabolism in elderly males with femoral neck fractures and depression[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(04): 435-439.

目的

分析老年男性股骨颈骨折合并抑郁患者骨密度和骨代谢生化指标变化，探讨抑郁对骨质疏松骨代谢的影响。

方法

选取于北京医院骨科2017年1月至2019年1月住院的老年男性股骨颈骨折患者102例。排除病理性骨折、认知功能障碍等患者。依据老年抑郁量表(GDS)将老年男性股骨颈骨折患者分为抑郁组和对照组。通过测定并比较两组患者的骨密度(BMD)、血清碱性磷酸酶(ALP)、血钙、血磷、25-羟基-维生素D[25(OH)D]、骨钙素(OC)、Ⅰ型原胶原氨基端前肽(P1NP)、血清Ⅰ型胶原羧基末端肽交联β特殊序列(β-CTX)水平，分析抑郁严重程度(GDS评分)与骨密度及骨代谢生化指标的相关性。分类变量的比较采用卡方检验，连续变量的比较采用t检验，两组连续性变量的相关性应用Pearson相关分析。

结果

抑郁组患者BMD明显低于对照组(腰椎t ＝5.964、髋部t ＝2.845，P <0.05)。与对照组相比，抑郁组血清25(OH)D水平下降(t ＝3.077，P <0.05)，抑郁组血清OC水平低于对照组(t ＝2.013，P <0.05)，而血清β-CTX水平高于对照组(t ＝2.938，P <0.05)，P1NP水平与对照组差异无统计学意义(t ＝0.684，P >0.05)。抑郁严重程度(GDS评分)与BMD(r＝-0.456，P <0.05)、25(OH)D(r＝-0.546，P <0.05)、OC(r＝-0.215，P <0.05)呈负相关，与P1NP(r＝-0.115，P>0.05)相关性不显著，与β-CTX(r＝0.372，P<0.05)呈正相关。

结论

抑郁症患者的骨形成标志物水平降低和骨吸收标志物水平升高，抑郁症是低骨密度和骨折的危险因素。应重视老年抑郁症患者骨代谢指标和25(OH)D的检测，及时进行维生素D的补充和有效的抗骨吸收药物治疗。

关键词: 骨质疏松, 股骨颈骨折, 抑郁, 维生素D, 骨密度
Objective

To analyze the changes of bone mineral density and biochemical markers of bone metabolism in elderly males with femoral neck fractures and depression, and to investigate the effect of depression on osteoporosis and bone metabolism.

Methods

Between January 2017 and January 2019 in Beijing Hospital, onehundredandtwo elderly males with femoral neck fractures were enrolled in the study.Pathological fracture and cognitive impairment were excluded. All the patients were divided into the depression group(52 cases) and the control group(50 cases) by geriatric depression scale (GDS). Bone mineral density (BMD) was detected using dual X-ray densitometry (DEXA). Bone metabolism biochemical markers, such as procollagen type Ⅰ N-peptide (P1NP), β isomer of C-terminal telopeptide of type Ⅰ collagen (β-CTX), osteocalcin(OC), 25-OH-VitD, alkaline phosphatase (ALP), calcium and phosphorus, were measured using enzyme linked immunosorbent assay (ELISA) method.Correlation of depression, bone metabolism and BMD was analyzed.The data were analyzed by chi-square test, t test, and Pearson correlation analysis.

Results

BMD of depression group was significantly lower than that of control group(lumbar t=5.964, hip neck t =2.845, P<0.05). Depression group(Compared with control group): the serum levels of 25(OH)D, OC, ALP and calcium were lower with statistically significant differences(t=3.077, 2.013, 2.111, 2.020, all P<0.05). β-CTX and phosphorus level were higher(t=2.938, 3.099, both P<0.05). No significant difference in P1NP (t =0.684, P>0.05). Depression scores were negatively correlated with BMD(r=-0.456, P<0.05), 25(OH)D (r=-0.546, P<0.05), OC (r=-0.215, P<0.05) and positively correlated with β-CTX(r=0.372, P<0.05), but not significantly correlated with P1NP (r=-0.115, P>0.05).

Conclusion

Depression is accompanied by the decrease of bone formation and increase of bone resorption, which is a risk factor for low bone density and fractures, so attention should be paid to the detection of bone metabolism makers and 25(OH)D in elderly patients with depression, and treating the osteoporosis in time.

Key words: Osteoporosis, Femoral neck fracture, Depression, Vitamin D, Bone mineral density
表1 抑郁组与对照组一般资料
组别 例数 年龄[岁，(±s)] 身高[cm，(±s)] 体重[kg，(±s)] BMI[kg/m2，(±s)] 吸烟情况(是/否) 慢性疾病病史(有/无) 有无配偶(无/有) 教育程度[年，(±s)]
抑郁组 52 74.6±5.3 174.3±3.9 68.5±5.4 22.8±1.3 20/32 35/17 23/29 9.4±1.4
对照组 50 75.2±3.1 173.5±4.7 69.6±4.4 23.1±0.9 18/32 34/16 12/38 11.9±1.7
统计值 t＝0.694 t＝0.937 t＝1.125 t＝1.350 χ2＝0.066 χ2＝0.006 χ2＝4.629 t＝7.757
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 <0.01
表2 两组BMD的比较[g/cm2，(±s)]
组别 例数 腰椎 髋部
抑郁组 52 0.72±0.08 0.60±0.04
对照组 50 0.84±0.12 0.65±0.12
t值 5.964 2.845
P值 <0.01 <0.01
表3 两组间骨代谢指标比较(±s)
组别 例数 25 (OH) D(μg/L) OC(μg/L) P1NP(μg/L) β-CTX(μg/L) ALP(U/L) 血钙(mmol/L) 血磷(mmol/L)
抑郁组 52 8.10±3.02 11.82±4.45 37.15±15.61 0.63±0.15 71.16±15.65 2.08±0.12 1.19±0.12
对照组 50 10.21±3.87 13.73±5.12 39.32±16.45 0.50±0.28 78.75±20.43 2.13±0.13 1.10±0.17
t值 3.077 2.013 0.684 2.938 2.111 2.020 3.099
P值 <0.01 <0.05 >0.05 <0.01 <0.05 <0.05 <0.01
[1]
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures[J]. Osteoporos Int, 2006, 17(12): 1726-1733.
[2]
Melton LJ, Elizabeth JA, O'connor MK, et al. Bone density and fracture risk in men[J]. J Bone Miner Res, 1998, 13(12): 1915-1923.
[3]
Melton LJ, Chrischilles EA, Cooper C, et al. Perspective how many women have osteoporosis？[J]. J Bone Miner Res, 2009, 7(9): 1005-1010.
[4]
Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture[J]. Osteoporos Int, 1997, 7(5): 407-413.
[5]
Hernlund E, Svedbom A, Ivergård M, et al. Osteoporosis in the European union: medical management, epidemiology and economic burden[J]. Arch Osteoporos, 2013, 8(1/2): 1-115.
[6]
Cizza G, Ravn P, Chrousos GP, et al. Depression: a major, unrecognized risk factor for osteoporosis？[J]. Trends Endocrinol Metab, 2001, 12(5): 198-203.
[7]
Aloumanis K, Mavroudis K. The " depressive" face of osteoporosis and the " osteoporotic" face of depression[J]. Hormones (Athens), 2013, 12(3): 350-362.
[8]
Cizza G, Primma S, Coyle M, et al. Depression and osteoporosis: a research synthesis with meta-analysis[J]. Horm Metab Res, 2010. 42(7): 467-482.
[9]
Schweiger U, Deuschle M, Körner A, et al. Low lumbar bone mineral density in patients with major depression [J]. Am J Psychiatry, 1994, 151(11): 1691-1693.
[10]
Schweiger U, Weber B, Deuschle M, et al. Lumbar bone mineral density in patients with major depression: evidence of increased bone loss at follow-up[J]. Am J Psychiatry, 2000, 157(1): 118-120.
[11]
Esel E, Ozsoy S, Tutus A, et al. Effects of antidepressant treatment and of gender on serum leptin levels in patients with major depression[J]. Prog Neuropsychopharmacol Biol Psychiatry, 2005, 29(4): 565-570.
[12]
Mussolino ME, Jonas BS, Looker AC. Depression and bone mineral density in young adults: results from NHANES III[J]. Psychosom Med, 2004, 66(4): 533-537.
[13]
Whooley M, Cauley JA, Zmuda JM, et al. Depressive symptoms and bone mineral density in older men[J]. J Geriatr Psychiatry Neurol, 2004, 17(2): 88-92.
[14]
Wong SY, Lau EM, Lynn H, et al. Depression and bone mineral density: is there a relationship in elderly Asian men? Results from Mr. Os (Hong Kong)[J]. Osteoporos Int, 2005, 16(6): 610-615.
[15]
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report[J]. J Psychiatr Res, 1983, 17(1): 37-49.
[16]
姚霞，高方美，连丽丽．老年男性代谢综合征与骨质疏松症的相关性研究[J]．中国骨质疏松杂志，2012，18(9):811-813.
[17]
Iolascon G, Cervone M, Gimigliano R, et al. Neuropsychiatric disorders in hip fracture[J]. Clin Cases Miner Bone Metab, 2011, 8(3): 49-53.
[18]
Holmes JD. Psychiatric illness in hip fracture[J]. Age Ageing, 2000, 29(6): 537-546.
[19]
Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk[J]. Lancet, 2002, 359(9321): 1929-1936.
[20]
Laudisio A, Marzetti E, Cocchi A, et al. Association of depressive symptoms with bone mineral density in older men: a population-based study[J]. Int J Geriatr Psychiatry, 2008, 23(11): 1119-1126.
[21]
Ganesan K, Teklehaimanot S, Tran TH, et al. Relationship of C-reactive protein and bone mineral density in community-dwelling elderly females[J]. J Natl Med Assoc, 2005, 97(3): 329-333.
[22]
Khosla S, Melton L3, Atkinson EJ, et al. Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: a key role for bioavailable estrogen[J]. J Clin Endocrinol Metab, 1998, 83(7): 2266-2274.
[23]
Gkiatas I, Lykissas M, Kostas-Agnantis I, et al. Factors affecting bone growth[J]. Am J Orthop (Belle Mead NJ), 2015, 44(2): 61-67.
[24]
Alghadir AH, Gabr S, Al EE. Physical activity and lifestyle effects on bone mineral density among young adults: sociodemographic and biochemical analysis[J]. J Phys Ther Sci, 2015, 27(7): 2261-2270.
[25]
Szulc P, Chapuy MC, Meunier PJ, et al. Serum undercarboxylated osteocalcin is a marker of the risk of hip fracture: a three year follow-up study[J]. Bone, 1996, 18(5): 487-488.
[26]
Hoogendijk WG, Paul L, Miranda GD, et al. Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults[J]. Arch Gen Psychiatry, 2008, 65(5): 508-512.
[27]
Petronijević M, Petronijević N, Ivković M, et al. Low bone mineral density and high bone metabolism turnover in premenopausal women with unipolar depression[J]. Bone, 2008, 42(3): 582-590.
[28]
Yazici AE, Bagis S, Tot S, et al. Bone mineral density in premenopausal women with major depression[J]. Joint Bone Spine, 2005, 72(6): 540-543.
[29]
Shaffer JA, Edmondson D, Wasson LT, et al. Vitamin D supplementation for depressive symptoms: a systematic review and meta-analysis of randomized controlled trials[J]. Psychosom Med, 2014, 76(3): 190-196.
[1] 中华医学会骨科学分会关节外科学组, 广东省医学会骨质疏松和骨矿盐疾病分会, 广东省佛山市顺德区第三人民医院. 中国髋部脆性骨折术后抗骨质疏松药物临床干预指南(2023年版)[J]. 中华关节外科杂志(电子版), 2023, 17(06): 751-764.
[2] 孟繁宇, 周新社, 赵志, 裴立家, 刘犇. 侧位直接前方入路髋关节置换治疗偏瘫肢体股骨颈骨折[J]. 中华关节外科杂志(电子版), 2023, 17(06): 865-870.
[3] 浦路桥, 徐永清, 齐保闯, 施洪鑫, 林玮, 卜鹏飞, 白艳, 唐志方, 李川. 中国髋部脆性骨折术后抗骨质疏松药物临床干预指南(2023年版)计划书[J]. 中华关节外科杂志(电子版), 2023, 17(05): 747-750.
[4] 王岩, 马剑雄, 郎爽, 董本超, 田爱现, 李岩, 孙磊, 靳洪震, 卢斌, 王颖, 柏豪豪, 马信龙. 外泌体在骨质疏松症诊疗中应用的研究进展[J]. 中华关节外科杂志(电子版), 2023, 17(05): 673-678.
[5] 陆宜仙, 张震涛, 夏德萌, 王家林. 巨噬细胞极化在骨质疏松中调控作用及机制的研究进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 538-541.
[6] 李婷, 张琳. 血清脂肪酸代谢物及维生素D水平与结直肠癌发生的关系研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 661-665.
[7] 方道成, 胡媛媛. 钙和维生素D与肾结石形成关系的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 653-656.
[8] 金浪, 石洁, 黄正, 贾永伟, 张建坡, 魏礼成, 金昊雷. 3D打印数字技术辅助改良交叉PVP对重度骨质疏松性椎体压缩骨折脊柱-骨盆矢状面平衡状态的影响[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 263-268.
[9] 王娟, 高俊, 周伊兰, 李小红, 史兵伟, 潘美珍. 血清IL-2、IL-17和骨密度关系及其对骨质疏松症的预测价值[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 295-300.
[10] 金宇杰, 虞宵, 周晓强, 李志强, 徐人杰, 张向鑫, 陈广祥. 动力交叉钉系统治疗股骨颈骨折其内固定位置与临床疗效的相关性研究[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 193-200.
[11] 宋晓亮, 郝海虎, 刘渊, 李浩江, 雷晓晶, 邵新中, 李卿源. 股骨重建钉治疗股骨颈骨折的疗效观察[J]. 中华老年骨科与康复电子杂志, 2023, 09(04): 201-208.
[12] 付强, 秦丽媛, 李全波. 神经病理性疼痛患者血清miR-15a水平及意义分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 293-298.
[13] 田明达, 吴珺, 王会娟, 张欣, 沙玉英, 陈琳, 赵宾洋. 6297名0~3岁婴幼儿超声骨密度检测结果分析[J]. 中华临床医师杂志(电子版), 2023, 17(06): 644-647.
[14] 周加军, 余永武, 周涵, 刘勇, 张凌. 甲状旁腺切除对继发性甲状旁腺功能亢进患者骨密度及骨代谢的影响[J]. 中华临床医师杂志(电子版), 2023, 17(06): 706-710.
[15] 潘惠, 王明, 杨忠, 杜向东. 低频重复经颅磁刺激辅助治疗伴不同特征抑郁症的对照研究[J]. 中华临床医师杂志(电子版), 2023, 17(05): 562-568.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号