股骨近端几何结构结合骨密度预测帕金森病髋部骨折的风险
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摘要
背景:帕金森病患者由于跌倒的风险较高且骨密度较低,骨折风险增加,了解髋部骨折相关危险因素及预测风险性至关重要。目的:测量帕金森患者骨密度与股骨近端几何结构变化,预测髋部骨折风险。方法:选择抚州市第一人民医院帕金森病患者62例作为帕金森病组,70例非帕金森病骨质疏松者作为非帕金森病骨质疏松组,以90例年龄和性别匹配的健康人群作为健康对照组。所有受试者对试验方案均知情同意,且得到抚州市第一人民医院伦理委员会批准。采用双能X射线骨密度仪及自带的髋部结构分析软件测量骨密度与股骨近端几何结构参数,股骨近端几何结构参数和骨密度的相关性采用Pearson相关分析。结果与结论:①比较3组受试者股骨颈干角、截面力矩,差异均无显著性意义(P> 0.05);②帕金森病组截面面积、骨皮质厚度小于非帕金森病骨质疏松组及对照组,屈曲应力比大于非帕金森病骨质疏松组及对照组,差异均有显著性意义(P <0.05);③骨密度与股骨颈、转子间截面面积、骨皮质厚度呈高度正相关(P <0.01),与屈曲应力比呈高度负相关(P <0.01),与股骨颈干角、截面力矩无相关性(P均>0.05);④提示帕金森患者骨密度减低,股骨近端结构发生改变,表现为骨截面面积、骨皮质厚度降低,屈曲应力比增高,增加帕金森病患者髋部骨折风险;髋部骨折发生与髋部骨密度及股骨近端几何结构改变有关。
BACKGROUND: Patients with Parkinson's disease have a high risk of falls and low bone density, so the incidence of fracture increases. It is important to understand the risk factors associated with hip fracture and predict risk.OBJECTIVE: To investigate the variations of hip bone mineral density and geometric structure of proximal femur in patients with Parkinson's disease, and to predict the risk for hip fracture.METHODS: Sixty-two cases of Parkinson's disease and 70 cases of osteoporotic non-Parkinson's disease at the First People's Hospital of Fuzhou as Parkinson's disease group were collected from the First People's Hospital of Fuzhou, and 90 healthy controls matched for sex and age were enrolled. All patients assigned the informed consents, and the study was approved by the Ethics Committee of the First People's Hospital of Fuzhou. The bone mineral density and geometric structure parameters of proximal femur were measured by dual-energy X-ray absorptiometry and hip structural analysis software and their correlations were analyzed by Pearson correlation analysis.RESULTS AND CONCLUSION:(1) There was no significant difference in the neck shaft angle and cross-sectional moment among groups(P >0.05).(2) The Parkinson's disease group had decreased cross sectional area and cortical thickness, and increased upper buckling ratio compared with the non-Parkinson's disease and healthy control groups(P < 0.05).(3) Bone mineral density showed positive correlation with cross sectional area and cortical thickness, and showed negative correlation with bucking ratio(P < 0.01). Bone mineral density had no correlation with neck shaft angle and cross-sectional moment of inertia both(both P > 0.05).(4) These results indicate that Parkinson's disease patients have low bone mineral density, decreased cross sectional area and cortical thickness, and high upper buckling ratio, which may increase the risk for hip fracture. Incidence of hip fracture is associated with the bone mineral density of hip and changed geometric structure of proximal femur.
BACKGROUND: Patients with Parkinson's disease have a high risk of falls and low bone density, so the incidence of fracture increases. It is important to understand the risk factors associated with hip fracture and predict risk.OBJECTIVE: To investigate the variations of hip bone mineral density and geometric structure of proximal femur in patients with Parkinson's disease, and to predict the risk for hip fracture.METHODS: Sixty-two cases of Parkinson's disease and 70 cases of osteoporotic non-Parkinson's disease at the First People's Hospital of Fuzhou as Parkinson's disease group were collected from the First People's Hospital of Fuzhou, and 90 healthy controls matched for sex and age were enrolled. All patients assigned the informed consents, and the study was approved by the Ethics Committee of the First People's Hospital of Fuzhou. The bone mineral density and geometric structure parameters of proximal femur were measured by dual-energy X-ray absorptiometry and hip structural analysis software and their correlations were analyzed by Pearson correlation analysis.RESULTS AND CONCLUSION:(1) There was no significant difference in the neck shaft angle and cross-sectional moment among groups(P >0.05).(2) The Parkinson's disease group had decreased cross sectional area and cortical thickness, and increased upper buckling ratio compared with the non-Parkinson's disease and healthy control groups(P < 0.05).(3) Bone mineral density showed positive correlation with cross sectional area and cortical thickness, and showed negative correlation with bucking ratio(P < 0.01). Bone mineral density had no correlation with neck shaft angle and cross-sectional moment of inertia both(both P > 0.05).(4) These results indicate that Parkinson's disease patients have low bone mineral density, decreased cross sectional area and cortical thickness, and high upper buckling ratio, which may increase the risk for hip fracture. Incidence of hip fracture is associated with the bone mineral density of hip and changed geometric structure of proximal femur.
引文
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[2]Mayor S.Parkinson's disease diagnosis is preceded by increased risk of falls,study finds.BMJ.2016;352:i695.
[3]Shribman S,Torsney KM,Noyce AJ,et al.A service development study of the assessment and management of fracture risk in Parkinson's disease.J Neurol.2014;261-266:1153-1159.
[4]Bhattacharya RK,Dubinsky RM,Lai SM,et al.Is there an increased risk of hip fracture in Parkinson’s disease?Anationwide inpatient sample.Mov Disord Off J Mov Disord Soc.2012;27:1440-1443.
[5]Critchley RJ,Khan SK,Yarnall AJ,et al.Occurrence,management and outcomes of hip fractures in patients with Parkinson's disease.Br Med Bull.2015;115(1):135-142.
[6]Pouwels S,Bazelier MT,Boer A,et al.Risk of fracture inpatients with Parkinson’s disease.Osteoporos Int 2013;24:2283-2290.
[7]刘文和,刘忠厚,陈鹏,等.老年人骨质疏松性髋部骨折与Singh指数和股骨近端几何结构的相关性初探[J].中国骨质疏松杂志,2012,18(3):193-196.
[8]Postuma RB,Berg D,Stern M,et al.MDS clinical diagnosis criteria for Parkinson's disease.Mov Disord.2015;30(12):1591-1601.
[9]张智海,刘忠厚,李娜,等.中国人骨质疏松症诊断标准专家共识(第三稿·2014版)[J].中国骨质疏松杂志,2014,20(9):1007-1010.
[10]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治指南[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.
[11]张志敏,盛志峰,廖二元.FRAX软件在骨折风险预测中的研究进展[J].中华内分泌代谢杂志,2012,28(12):1029-1032.
[12]Chen YY,Cheng PY,Wu SL,et al.Parkinson’s disease and risk of hip fracture:an8-year follow-up study in Taiwan.Parkinsonism Relat Disord.2012;18:506-509.
[13]Tan L,Wang Y,Zhou L,et al.Parkinson’s disease and risk of fracture:a meta-analysis of prospective cohort studies.PLoSOne.2014;9:e94379.
[14]Malochet-Guinamand S,Durif F,Thomas T.Parkinson's disease:A risk factor for osteoporosis.Joint Bone Spine.2015;82(6):406-410.
[15]Torsney KM,Noyce AJ,Doherty KM,et al.Bone health in Parkinson's disease:a systematic review and meta-analysis.J Neurol Neurosurg Psychiatry.2014;85-10:1159-1166.
[16]戴鹤玲,孙天胜,刘智.髋部骨密度和几何结构与老年髋部骨折发病的关系[J].中国老年学杂志,2013,33(2):294-296.
[17]胡世弟,李瑾,刘璐,等.绝经后2型糖尿病患者髋部骨几何结构参数及影响因素[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(1):13-20.
[18]Zhang H,Hu YQ,Zhang ZL.Age trends for hip geometry in Chinese men and women and the association with femoral neck fracture.Osteoporos Int.2011;22:2513-2522.
[19]Alonso CG,Curiel MD,Carranza FH,et al.Femoral bone mineral density,neck shaft angle and mean femoral neck width as predictors of hip fracture in men and women.Osteoporos Int.2000;11:714-720.
[20]张扬,雷伟,吴子祥.老年股骨上段标本几何参数及骨密度与生物力学性能的相关性分析[J].中国骨质疏松杂志,2009,15(1):32-35.
[21]任晓静,蔡思清,吕国荣,等.髋部结构分析在预测髋部脆性骨折的意义[J].中国医学物理学杂志,2017,34(5):513-520.
[22]Lacroix AZ,Beck TJ,Cauley JA,et al.Hip structural geometry and incidence of hip fracture in postmenopausal women:what does it add to conventional bone mineral density?Osteoporos Int.2010;21:919-929.
[23]Gnudi S,Ripamonti C,Lisi L,et al.Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women.Osteoporos Int.2002;13(1):69.
[24]黄际远,宋文忠,史克俭,等.成都地区健康人群髋部骨密度及几何参数变化的初步研究[J].中国骨质疏松杂志,2012,18(9):798-802.
[25]Dawson-Huqhes B,Tosteson AN,Melton LJ 3rd,et al.Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA.Osteoporos Int.2008;19(4):449-458.
[2]Mayor S.Parkinson's disease diagnosis is preceded by increased risk of falls,study finds.BMJ.2016;352:i695.
[3]Shribman S,Torsney KM,Noyce AJ,et al.A service development study of the assessment and management of fracture risk in Parkinson's disease.J Neurol.2014;261-266:1153-1159.
[4]Bhattacharya RK,Dubinsky RM,Lai SM,et al.Is there an increased risk of hip fracture in Parkinson’s disease?Anationwide inpatient sample.Mov Disord Off J Mov Disord Soc.2012;27:1440-1443.
[5]Critchley RJ,Khan SK,Yarnall AJ,et al.Occurrence,management and outcomes of hip fractures in patients with Parkinson's disease.Br Med Bull.2015;115(1):135-142.
[6]Pouwels S,Bazelier MT,Boer A,et al.Risk of fracture inpatients with Parkinson’s disease.Osteoporos Int 2013;24:2283-2290.
[7]刘文和,刘忠厚,陈鹏,等.老年人骨质疏松性髋部骨折与Singh指数和股骨近端几何结构的相关性初探[J].中国骨质疏松杂志,2012,18(3):193-196.
[8]Postuma RB,Berg D,Stern M,et al.MDS clinical diagnosis criteria for Parkinson's disease.Mov Disord.2015;30(12):1591-1601.
[9]张智海,刘忠厚,李娜,等.中国人骨质疏松症诊断标准专家共识(第三稿·2014版)[J].中国骨质疏松杂志,2014,20(9):1007-1010.
[10]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治指南[J].中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.
[11]张志敏,盛志峰,廖二元.FRAX软件在骨折风险预测中的研究进展[J].中华内分泌代谢杂志,2012,28(12):1029-1032.
[12]Chen YY,Cheng PY,Wu SL,et al.Parkinson’s disease and risk of hip fracture:an8-year follow-up study in Taiwan.Parkinsonism Relat Disord.2012;18:506-509.
[13]Tan L,Wang Y,Zhou L,et al.Parkinson’s disease and risk of fracture:a meta-analysis of prospective cohort studies.PLoSOne.2014;9:e94379.
[14]Malochet-Guinamand S,Durif F,Thomas T.Parkinson's disease:A risk factor for osteoporosis.Joint Bone Spine.2015;82(6):406-410.
[15]Torsney KM,Noyce AJ,Doherty KM,et al.Bone health in Parkinson's disease:a systematic review and meta-analysis.J Neurol Neurosurg Psychiatry.2014;85-10:1159-1166.
[16]戴鹤玲,孙天胜,刘智.髋部骨密度和几何结构与老年髋部骨折发病的关系[J].中国老年学杂志,2013,33(2):294-296.
[17]胡世弟,李瑾,刘璐,等.绝经后2型糖尿病患者髋部骨几何结构参数及影响因素[J].中华骨质疏松和骨矿盐疾病杂志,2015,8(1):13-20.
[18]Zhang H,Hu YQ,Zhang ZL.Age trends for hip geometry in Chinese men and women and the association with femoral neck fracture.Osteoporos Int.2011;22:2513-2522.
[19]Alonso CG,Curiel MD,Carranza FH,et al.Femoral bone mineral density,neck shaft angle and mean femoral neck width as predictors of hip fracture in men and women.Osteoporos Int.2000;11:714-720.
[20]张扬,雷伟,吴子祥.老年股骨上段标本几何参数及骨密度与生物力学性能的相关性分析[J].中国骨质疏松杂志,2009,15(1):32-35.
[21]任晓静,蔡思清,吕国荣,等.髋部结构分析在预测髋部脆性骨折的意义[J].中国医学物理学杂志,2017,34(5):513-520.
[22]Lacroix AZ,Beck TJ,Cauley JA,et al.Hip structural geometry and incidence of hip fracture in postmenopausal women:what does it add to conventional bone mineral density?Osteoporos Int.2010;21:919-929.
[23]Gnudi S,Ripamonti C,Lisi L,et al.Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women.Osteoporos Int.2002;13(1):69.
[24]黄际远,宋文忠,史克俭,等.成都地区健康人群髋部骨密度及几何参数变化的初步研究[J].中国骨质疏松杂志,2012,18(9):798-802.
[25]Dawson-Huqhes B,Tosteson AN,Melton LJ 3rd,et al.Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA.Osteoporos Int.2008;19(4):449-458.
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