| Background and purpose:With the advent of the aging society,the incidence of osteoporosis and osteoporotic fracture in southwest China is getting higher,which not only affects the health and quality of life of patients,but also brings huge medical costs to the society.The 2017 edition of diagnostic guidelines for primary osteoporosis in China has added "diagnosis based on fragile fracture" form the WHO diagnostic criteria,which will increase the number of people with osteoporosis and expand the population of drug intervention,exposing a portion of the population without osteoporosis to drug therapy.According to some views at home and abroad,it is doubtful that expanding the intervention of osteoporosis can reduce the risk of fracture in the future.In this study,we searched for possible differences in bone mineral density between patients with common fragility fractures and age-and gender-matched non-fracture physical examination populations,as well as the differences in the prevalence of osteoporosis under the two diagnostic criteria in the middle-aged and elderly fragility fracture patients in southwestern China.According to the demographic characteristics and risk factors of fragility fractures in the middle-aged and elderly population in southwestern China,data reference is provided for establishing osteoporosis diagnostic criteria and fracture risk assessment tools more suitable for Chinese people.Materials and Methods:According to the inclusion and exclusion criteria,a total of 647 patients with fragility fractures of lumbar vertebrae,hip,proximal humerus and distal radius aged from 50 to90 years old were collected from July 2019 to September 2021,including 490 females and 157 males,and 354 normal subjects matched with the age and sex of patients with fragile fractures,including 250 females and 104 males.Because of the large age span of patients with fragility lumbar and hip fractures,these two types of fractures were divided into 50-74 years old and 75-90 years old according to WHO age.The bone mineral density(BMD)and T value of L1-L4,femoral neck and total hip were measured by dual energy X-ray absorptiometry(DXA),and the osteoporosis rate was calculated.The bone mineral density and osteoporosis rate of each fragility fracture group were compared according to age,sex and matched control group.Finally,the prevalence rates of osteoporosis in each fragility fracture group were calculated and compared according to the diagnostic criteria of osteoporosis in China and WHO.Result:1.From 50 to 90 years old,according to WHO diagnostic criteria,the prevalence rate of osteoporosis in women with fragile lumbar spine and hip fractures was as high as70.5% and 65.5% respectively,while that in men was 38.6% and 36.4% respectively.The prevalence rates of osteoporosis in female patients with fragility proximal humeral fracture and distal radius fracture were 36.5% and 31.6%,respectively,while those in male patients were 13.3% and 15.8%,respectively,which were higher than those without fracture in the same sex and age group.2.From 50 to 74 years old,the bone mineral density of any part of female patients with fragile lumbar and hip fractures was significantly lower than that of normal controls,and the diagnosis rate of osteoporosis in patients with fragile lumbar and hip fractures was significantly higher than that in the control group under WHO diagnostic criteria,but in 75-90 years old,the two results were opposite.3.There was no significant difference in bone mineral density between female patients with fragility proximal humerus fracture and distal radius fracture and normal control group(P > 0.05).4.From 50 to 74 years old,the bone mineral density(BMD)of male patients with fragile lumbar and hip fractures was significantly lower than that of normal controls(P <0.05).5.Regardless of gender and type of fragile fracture,compared with WHO standard,the number of patients with osteoporosis increased significantly under Chinese osteoporosis diagnostic criteria,especially in women aged 50-74 years old.Conclusions:1.The osteoporosis rate of patients with fragility fracture in southwest China is significantly higher than that of normal non-fragile people of the same age and sex,and the prevalence rate of osteoporosis is serious.2.According to the 2017 diagnostic criteria of osteoporosis in southwest China,compared with the diagnostic criteria of WHO,the population of osteoporosis has been expanded,especially in women aged 50-74 years with lumbar and hip fractures.3.The baseline reference level of "referring to WHO and based on the results of bone mineral density measurement by DXA" in the diagnostic criteria of osteoporosis in China is confused.4.Call for the establishment and use of bone mineral density reference lines and databases based on Chinese people,so as to provide more appropriate guidance and direction for clinical experience and scientific research of osteoporosis in China. |
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