老年骨质疏松患者血清25-羟维生素D3水平与骨代谢指标及骨折风险的关系研究

Associations of serum 25-hydroxyvitamin D3 with bone metabolic markers and fracture risk in elderly patients with osteoporosis

摘要:

目的 分析老年骨质疏松患者血清25-羟维生素D₃［25（OH）D₃］水平与骨代谢指标及骨折风险的关系。方法 选取2022年1月—2024年10月晋江市医院收治的106例老年骨质疏松患者为观察组，另取同期该院健康体检者81例为对照组。比较观察组与对照组血清25（OH）D₃、β-胶原特殊序列（β-CTX）、总1型胶原氨基端延长肽（TP1NP）水平，并通过Pearson法对血清25（OH）D₃水平与β-CTX、P1NP水平进行相关性分析。对观察组患者进行为期1年的随访，根据患者是否发生骨质疏松性骨折（OPF）分为OPF组与非OPF组，比较两组血清25（OH）D₃、β-CTX、TP1NP水平，并进行多因素一般Logistic回归分析，绘制受试者工作特征（ROC）曲线，评估血清25（OH）D₃、β-CTX、TP1NP水平及其联合检测对OPF的预测价值。结果 观察组25（OH）D₃水平低于对照组，β-CTX、TP1NP水平均高于对照组（P 0.05）。Pearson相关性分析结果表明，25（OH）D₃水平与β-CTX水平（r =-0.450，P =0.000）、TP1NP水平（r =-0.410，P =0.000）均呈负相关。OPF组25（OH）D₃水平低于非OPF组，β-CTX、TP1NP水平高于非OPF组（P 0.05）。多因素一般Logistic回归分析结果表明：25（OH）D₃水平高［O^R=0.799（95% CI：0.642，0.994）］为骨质疏松患者发生OPF的保护因素（P 0.05），β-CTX水平高［O^R=51.449（95% CI：5.418，488.578）］、TP1NP水平高［O^R=1.262（95% CI：1.109，1.435）］均为骨质疏松患者发生OPF的危险因素（P 0.05）。ROC曲线结果表明，三者联合检测对骨质疏松患者发生OPF有较高的预测效能，敏感性为78.1%（95% CI：0.600，0.907），特异性为93.2%（95% CI：0.849，0.978）。结论 血清25（OH）D₃水平降低与β-CTX、TP1NP水平升高是老年骨质疏松患者发生OPF的危险因素，且三者联合检测对OPF具有较高的预测效能。

Abstract:

Objective To analyze the associations of serum 25-hydroxyvitamin D₃ [25(OH)D₃] with bone metabolic markers and fracture risk in elderly patients with osteoporosis.Methods A total of 106 elderly patients with osteoporosis admitted to our hospital between January 2022 and October 2024 were selected as the observation group. Additionally, 81 healthy individuals who underwent health check-ups at the same hospital during the same period were selected as the control group. Serum levels of 25(OH)D₃, beta-CrossLaps (β-CTX) and total procollagen type 1 N-terminal propeptide (TP1NP) were compared between the observation group and the control group, and Pearson's correlation analysis was performed to assess the relationship between serum 25(OH)D₃ levels and those of β-CTX and TP1NP. Patients in the observation group were followed up for one year and classified into an osteoporotic fracture (OPF) group and a non-OPF group based on whether they had sustained an osteoporotic fracture. Serum levels of 25(OH)D₃, β-CTX and TP1NP were compared between the two groups, and the multivariable general logistic regression analysis was performed. Receiver operating characteristic (ROC) curves were plotted to assess the predictive value of serum 25(OH)D3, β-CTX, TP1NP levels, and their combination for OPF.Results The 25(OH)D₃ levels in the observation group were lower than those in the control group, whilst β-CTX and TP1NP levels were both higher in the observation group than in the control group (P 0.05). Pearson correlation analysis revealed that 25(OH)D₃ levels were negatively correlated with β-CTX levels (r = -0.450, P = 0.000) and TP1NP levels (r = -0.410, P = 0.000). The 25(OH)D₃ levels in the OPF group were lower than those in the non-OPF group, whilst β-CTX and TP1NP levels were higher in the OPF group than in the non-OPF group (P 0.05). The multivariable general logistic regression analysis indicated that high 25(OH)D₃ levels [O^R = 0.799 (95% CI: 0.642, 0.994) ] were a protective factor against the development of OPF in patients with osteoporosis (P 0.05), whilst high β-CTX levels [O^R = 51.449 (95% CI: 5.418, 488.578) ] and high TP1NP levels [O^R = 1.262 (95% CI: 1.109, 1.435) ] were both risk factors for the development of OPF in patients with osteoporosis (P 0.05). The ROC curve analysis indicated that the combined detection of these three markers demonstrated high predictive performance for OPF in patients with osteoporosis, with a sensitivity of 78.1% (95% CI: 0.600, 0.907) and a specificity of 93.2% (95% CI: 0.849, 0.978).Conclusion Reduced serum 25(OH)D₃ levels and elevated β-CTX and TP1NP levels are risk factors for OPF in elderly patients with osteoporosis, and the combined detection of these three markers demonstrates high predictive efficacy for OPF.