中國大陸地區(qū)早期診斷骨質(zhì)疏松癥及干預閾值探討

中國大陸地區(qū)早期診斷骨質(zhì)疏松癥及干預閾值探討中國醫(yī)科大學航空總醫(yī)院骨科張智海2016-10北京人口平均預期壽命達到74.83歲男性為72.38歲；女性為77.37歲60歲及以上的人口占總?cè)丝?3.26％總數(shù)1.79億至2050年，我國預計老齡人口將達人口總數(shù)的1/3面臨老年社會壓力

更需要關(guān)注骨質(zhì)疏松癥2010年第六次全國人口普查國家統(tǒng)計局人口和就業(yè)統(tǒng)計司.中國人口和就業(yè)統(tǒng)計年鑒——2014[M].北京:中國統(tǒng)計出版社,2015北京等地區(qū)50歲以上女性脊椎骨折患病率為15%

相當于每7名（50歲以上）女性中就有1名發(fā)生

脊椎骨折2013年國際骨質(zhì)疏松基金會(InternationalOsteoporosisFoundation，IOF)

年鑒顯示

全世界1/3女性和1/5男性會發(fā)生

一次骨質(zhì)疏松性骨折流行病學XuL,JBoneMinerRes,2000,15(10):2019-2025InternationalOsteoporosisFoundation．

Epidemiology，

costs＆

burdenofosteoporosisin2013骨質(zhì)疏松性骨折105歲骨質(zhì)疏松性骨折+PKP60歲-2.0SD單純使用骨密度值判斷骨質(zhì)疏松癥將漏診很多骨折！

------(NORA)研究WHO骨質(zhì)疏松癥診斷標準測量方法：DXA股骨頸正常:T-scoregreaterthanorequalto?1SD低骨量(osteopenia):T-score<?1and>?2.5SD.骨質(zhì)疏松:T-scorelessthanorequalto?2.5SD重度骨質(zhì)疏松(establishedosteoporosis):T-scorelessthanorequalto?2.5SDinthepresenceof1ormorefragilityfractures為什么測量骨密度?預測未來

發(fā)生骨折

的可能性骨密度值能準確預測未來發(fā)生骨折的可能性嗎?能!但是準確性有很多干擾因素!哪些因素會產(chǎn)生影響呢?年齡性別7種風險因子（即往骨折史吸煙父母的髖部骨折史皮質(zhì)激素使用史酗酒史體重指數(shù)類風濕性關(guān)節(jié)炎

)WHO骨折風險因子WHO骨質(zhì)疏松癥診斷采用的是髖部或脊柱的骨密度值低于白人婦女峰值骨量的2.5SDbyDXA設備

峰值骨量5%—17%差異忽略差異?\改變標準?T<-2.5SD髖部骨折發(fā)病率T<-2SD不同種族峰值骨量差異---腰椎COUNTRYRACECASEAGESLUMBAR2-4USACaucasian16422.1±0.051.136±0.011NetherlandsCaucasian97271.143±0.138NetherlandsCaucasian9827-291.143±0.013FinlandCaucasian3135-451.038±0.154BelgiumCaucasian3925-351.035±0.109Greece3730-391.044±0.10JapanYELLOW28335-391.051±0.115Hongkong[21]YELLOWYELLOW23621-400.994±0.126Hongkong[8]YELLOW17331-401.010±0.12Taipei42430-391.078±0.133TianjinChinaYELLOW2225-301.085±0.149China[26]3730-391.055±0.115LiuGY,《ChineseJournalofosteoporosis》2007,13(2):101-104-5.6%Caucasian不同種族峰值骨量差異---股骨頸countryraceCaucasiancaseagesFemoralneckUSACaucasian16422.1±0.051.069±0.009FinlandYellow13225-300.943±0.104Greece3320-290.923±0.110Japan24315-190.849±0.099HongkongYellow14520-390.766±0.110HongkongYellow28921-400.832±0.118HongkongYellow23621-400.831±0.117HongkongYellow17331-400.840±0.120TaibeiYellow16317-290.873±0.101ChinaYellow8520-290.855±0.125-17.1%LiuGY,《ChineseJournalofosteoporosis》2007,13(2):101-104髖部骨折發(fā)病率CHINA

(HONGKONG)389100000Sweden739100000Norway737100000England603100000USA617100000劉明珠,從全球的角度看亞洲骨質(zhì)疏松癥的流行病學,國外醫(yī)學內(nèi)分泌分冊，2004，24（4）：222-223白色人種亞洲≈40%

差異

CHINA

(HONGKONG)劉明珠,從全球的角度看亞洲骨質(zhì)疏松癥的流行病學,國外醫(yī)學內(nèi)分泌分冊，2004，24（4）：222-223Caucasianages(yrs)HipFrxhipFrxSpineFrxCollisFrxFemale髖部骨折發(fā)病率白色人種亞洲≈28%

差異

為何出現(xiàn)如此差異？-----主要是人種差異

A:峰值骨量B:髖部骨折發(fā)病率5%—40%差異忽略之?\改變之?T<-2.5SDT<-2SD白人亞洲人種一項回顧性研究

采用診斷標準T值≤-2.5SD或-2.0SD數(shù)據(jù)薈萃分析來源于“萬方數(shù)據(jù)”+中國醫(yī)院知識數(shù)據(jù)庫(CHKD)

中國醫(yī)學期刊雜志文獻from1994to2015and檢測骨密度設備DXA,pDXA,SPA,RA測量位置:腰椎、股骨頸等(From:OCCGS,OsteoporosisCommitteeofChinaGerontologicalSociety)AretrospectiveliteraturestudyofosteoporosisprevalencerateinmainlandChinawhenthediagnosiscriterionis-2.5SDor-2.0SD數(shù)據(jù)來源：112全文文獻

包括男性42882例次、女性樣本51264例次摘取年齡、測量部位、骨質(zhì)疏松發(fā)病率等、設備型號、其中30片文獻有完整數(shù)據(jù)表SPSS17.0軟件作為統(tǒng)計(From:OCCGS,OsteoporosisCommitteeofChinaGerontologicalSociety)40歲以上中國大陸地區(qū)骨質(zhì)疏松發(fā)病率女性骨質(zhì)疏松癥發(fā)病率Referances4527113Average+/-SD40-9.6%5.6%5.65%9%4.7%3.65%6.37%±2.39%50-21%25%25%10%24.8%24.7%21.75%±5.96%60-44%48.5%48.5%25.7%63%48.6%46.38%±12.03%70-55.6%70%70.4%49%67%73.9%64.32%±9.79%80-67.7%78%78.7%--77.7%81.6%76.74%±5.28%男性骨質(zhì)疏松癥發(fā)病率

Referances4527113Average+/-SD40-1.6%5.3%5.3%2.3%4.8%5.35%4.11%±1.70%50-12.3%18%18%2.5%8.8%17.8%12.90%±6.35%60-20.6%26.5%26.5%8.2%11.1%26.5%19.90%±8.31%70-22.3%31.7%29.1%37.6%17.8%35.3%28.97%±7.63%80-24%43.6%43.6%60%20%47.5%39.78%±15.09%OP診斷標準T≤-2.5SD女性OPrate男性OPrate每10年男性骨質(zhì)疏松癥增加9%，女性增加18%40-50-60-70-80-（yrs）OP診斷標準T≤-2.5SDAges(yrs)Male(people）MaleprevalencerateMaleOPPEOPLEFemale(people）FemaleprevalencerateFemaleOPPEOPLETotleOPpeople40-1173850964.11%48245271129634216.37%71957691202029650-8144617212.90%105065567861947321.75%170997352760629160-5058289719.90%100659964919766746.38%228178773288387370-2768231228.97%80195652914221864.32%1874427526763840≥80-877475239.78%34905961221459476.74%937348012864076Totleosteoporosispeople:11213837640歲以上OP發(fā)病率：112138376/（男285871229+女282137373）=0.1974骨質(zhì)疏松發(fā)病率約約1.12億人男女比例約1:220%OP診斷標準T≤-2.5SD5%—40%差異T≤-2.5SDT≤-2.0SD高加索人種亞洲人種OP診斷標準

女性OP發(fā)病率%

男性OP發(fā)病率%

REFERENCE40-50-60-70-80-REFERENCE40-50-60-70-80-(4)28.834.35990(17)09.328.133.650.2腰椎(4)3.39.338.762.591(4)1.75.219.45085.7(6)9.88538.262.8179.8289.06(5)

6.621.6241.36(12)8.121.353.373.1

(5)14.7451.2574.42(4)26.6215388.9股骨頸(7)7.843.754.985.189.5(6)8.44523.9930.8138.8647.22(8)7.142.65586.188.2(7)5.725.330.138.964(9)2.1224.3566.16(8)5.124.829.239.561.1(10)21.7154.0965.1475.14(9)5.08524.0252.97(11)22.945.1565.9(10)20.3931.941.7252.42T-test

P>0.05P>0.05P>0.05P>0.05

P>0.05P<0.05P>0.05P>0.05P>0.05X7.7528.0052.6773.4589.55

4.0015.7330.5543.4666.19SD6.3815.7210.769.531.04

2.909.4910.797.3017.56OP診斷標準T≤-2.0SDAges(yrs)Male(people）Maleprevalencerate

MaleOPPEOPLEFemale(people）FemaleprevalencerateFemaleOPPEOPLETotleOPpeople40-1173850964.00%47004351129634217.75%87567831345721850-8144617215.73%128089387861947328.00%220122733482121160-5058289730.55%154516704919766752.67%259131494136481970-2768231243.46%120295222914221873.45%2140593133435452≥80-877475266.19%58077161221459489.55%1093853516746251Totleosteoporosispeople以上OP發(fā)病率：139824951/（男285871229+女282137373）=0.2462骨質(zhì)疏松發(fā)病率大約

約1.4億人

25%OP診斷標準T≤-2.0SD男性和女性OP發(fā)病率比較(40歲以上)40-50-60-70-80-（yrs）FemaleOPrateMaleOPrate

OP診斷標準T≤-2.0SD每10年男性骨質(zhì)疏松癥增加15%，女性增加21%6.37%89.55%66.19%76.74%39.78%73.45%43.46%64.32%28.97%52.67%30.55%46.38%19.90%28.00%15.73%21.75%12.90%7.75%4.00%4.11%OPcriterionis-2.0SDOPcriterionis-2.5SDMalefemaleMalefemale40-50-60-70-80-70-、80-歲年齡段，男性和女性骨質(zhì)疏松發(fā)病率不相同，那個更為合理？OP診斷標準T≤-2.0SDOP診斷標準T≤-2.5SD女性OP