JCEM：腹部脂肪的减少增加骨折风险

不同腹部脂肪患者的股骨颈和腰椎BMD

较高的体重与更高的骨矿密度（BMD）和更低的骨折风险相关。然而，由于有限的前瞻性数据，腹部脂肪量与骨折风险的关系仍不清楚。为了探讨腹部脂肪量、BMD和骨折风险之间的关系，来自澳大利亚加文医学研究所的Tuan V Nguyen教授及其团队进行了一项研究，该研究认为腹部脂肪的减少增加骨折风险。该研究结果在线发表在2012年4月4日的美国《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）上。
该研究是一项前瞻性调查研究，一个由1126例（360例男性和766例女性）年龄50+岁受试者组成的样本被平均连续随访5年。受试者的平均年龄是71岁（57-94）。在基线，采用双能X线吸收法（GE-LUNAR Corp, Madison, WI）测量股骨颈和腰椎BMD、以及腹部脂肪量。低创伤性和非病理性骨折的发病率由X线报告前瞻性的确定。
该研究结果表明，在随访期间，17例男性和107例女性出现骨折。在女性，校正年龄，股骨颈BMD，身高，体力活动和先前骨折后，腹部脂肪量每降低1kg与骨折风险增加50%相关（HR：1.50；95%CI：1.10-2.05）。骨折类型的亚组分析发现这种相关性主要在临床椎骨骨折中观察到（HR：1.94；1.22-3.13）。在男性，尽管在腹部脂肪量与骨折风险之间没有统计学意义的相关（HR：1.15；95%CI：0.58-2.25），这一发现受到骨折数量低的负面影响。
该研究发现，在女性，较低的腹部脂肪与更高的骨折风险显著相关。

 与骨折相关的拓展阅读：

• J Hepatol：肝硬化患者骨折风险增高
• AAOS批准首个桡骨远端骨折合理应用标准
• AAOS 2013：吸烟或延长骨折愈合时间
• A＆R：萎缩型髋部OA患者发生骨质疏松性骨折的风险高
• JAMA Intern Med：非苯二氮类安眠药可能升高老人骨折风险
• Diabetes Care：糖尿病增高骨折相关住院风险
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Association between Abdominal Obesity and Fracture Risk: A Prospective Study
Context
Higher body weight is associated with greater bone mineral density (BMD) and lower fracture risk. However, the relationship between abdominal fat mass and fracture risk is unclear due to limited prospective data. The present study sought to examine the association between abdominal fat mass, BMD and fracture risk.
Methods
The study was designed as a prospective investigation, in which a sample of 1126 participants (360 men and 766 women) aged 50+ years had been continuously followed up for an average of 5 years. The mean age of participants was 71 years (range: 57–94). At baseline, BMD at the femoral neck and lumbar spine, and abdominal fat mass were measured by dual energy X-ray absorptiometry (GE-LUNAR Corp, Madison, WI). The incidence of low-trauma and non-pathological fractures was ascertained prospectively from X-ray reports.
Results
During the follow-up period, 19 men and 107 women had sustained a fracture. In women, each 1 kg lower abdominal fat mass was associated with a 50% higher risk of fracture (hazard ratio [HR]: 1.50; 95% CI: 1.10–2.05) after adjusting for age, femoral neck BMD, falls, stature, physical activity and prior fracture. Subgroup analysis by fracture type found that the association was mainly observed in clinical vertebral fracture (HR: 1.96; 1.22–3.13). In men, although there was no statistically significant association between abdominal fat mass and fracture risk (HR: 1.15; 95% CI: 0.58–2.25), the strength this finding is negatively impacted by low number of fractures.
Conclusions
Lower abdominal fat was significantly associated with an higher fracture risk in women.