| ObjectiveUnified epidemiological investigation,physical examination and laboratory examination were carried out among residents of several towns and townships in Tibet.To understand the status quo of osteoporosis in adult population in Xizang.The influencing factors of bone loss and osteoporosis were analyzed for 19 indexes included.To explore the relationship between MTHFR C677 T gene polymorphism and bone density.To explore the screening value of OSTA index and body mass index for osteoporosis among middle-aged and elderly Tibetan residents in Tibet.MethodsQuestionnaire survey,physical examination and laboratory examination were conducted among the residents of Geze County(Dongcuo Township),Nyima County(Nyima Township),Anduo County(Antdui Township and Cuoma Township),Shuanghu County,Bangor County(Jiacong Township),Shannan City(Longzi County,Naidong District)and other townships in Tibet.The questionnaire included general demographic information and life style,including name,gender,age,ethnicity,poverty,education,marital status,employment status,etc.Lifestyle includes smoking and alcohol consumption,weekly physical activity frequency,etc.;Physical examination includes measurement of chest circumference,waist circumference,height,weight,oxygen saturation and blood pressure.Laboratory tests include biochemical indicators such as uric acid(UA),creatinine(CREA),cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C)and MTHFR C677 T rs1801133,Detection of two sites MTHFR A1298 C rs1801131.Non-parametric test Kruskal Wallis was used to compare the difference in the detection rate of bone status among various variables.One-way ANOVA was used to compare the T-value of bone density in age and BMI groups,and one-way ANOVA was used to compare the relationship between blood lipid indexes and bone status.The classification of osteoporosis(normal bone mass,decreased bone mass,osteoporosis)was used as the dependent variable for disordered multiclassification Logistic regression analysis.Bilateral test was used,and the test level was =0.05.Multiple linear regression was used to analyze the relationship between bone mineral density and C677 T genotype.The authors characteristic curve(ROC)was used to evaluate the efficacy,sensitivity,specificity and area under the curve(AUC)were calculated,and the screening value of OSTA index and BMI for OP was compared.Results一、Among the 1319 people in this survey,the positive rate of bone loss was 42.8% and the positive rate of osteoporosis was 3.5%.Bone loss and osteoporosis were detected in 37.5 percent of women and 3.7 percent of women.The prevalence of bone loss and osteoporosis in males was 49.7percent and 3.1 percent,respectively.The bone mass decreased by 55.7%and the positive rate of osteoporosis was 8.3%.Female bone mass decreased by 52.3% and the positive rate of osteoporosis was 9.1%.In men,bone mass decreased by 60.7% and osteoporosis rate was 7.1%.The bone mass decreased by 65.5% and the detection rate of osteoporosis was 14.7%.Female bone mass decreased by 64.5% and the positive rate of osteoporosis was 15.9%.In men,bone mass decreased by 67.0% and osteoporosis was detected by 12.8%.The bone mass decreased by 64.2% and the detection rate of osteoporosis was 27.2%.Female bone mass decreased by 66.7%and the positive rate of osteoporosis was 25.5%.Male bone mass decreased by 60.0% and the positive rate of osteoporosis was 30.0%.二、The detection rate of osteoporosis of female subjects in different BMI groups was different,the difference was statistically significant(P <0.001);The detection rates of osteoporosis of male subjects in different BMI groups were also different,the difference was statistically significant(P < 0.001).Multiple logistic regression analysis showed that increased BMI was a protective factor for abnormal bone mass in the total sample,female and male groups(P < 0.05).The screening value of OSTAS index and body mass index for osteoporosis in middle-aged and elderly Tibetan residents in Tibet showed that: the group with AUC greater than or equal to 0.9 Male OSTA index(sensitivity 100%,specificity 85.2%),male quasielderly OSTA index(sensitivity 85.7%,specificity 89.6%),male middleaged BMI(sensitivity 100%,specificity 100%),male middle-aged OSTA index(sensitivity 100%,specificity 100%,100% specificity),OSTA index in middle age(sensitivity 100%,specificity 79.6%).Women with AUC greater than 0.8 and sensitivity and specificity greater than or equal to 80% :female elderly OSTA index(sensitivity 80%,specificity 91.7%),female OSTA index(sensitivity 84%,specificity 81.4%).三、There was a correlation between age,BMI and bone mineral density T value(P < 0.001),and the correlation between BMI and bone mineral density T value was higher than age.Age(r=-0.359;Male r=-0.199)BMI(female r=0.459;Male r=0.453).The bone mineral density T-values of male and female subjects in different age groups showed statistically significant differences(P < 0.001).In the same age group,there was no statistical difference between the two groups except 60～69 and 70～79,while the bone mineral values T-values of male and female subjects in other age groups showed statistically significant differences(P < 0.05).In the age group 20-59,the bone mineral density of T-value of females was higher than that of males,and the difference was statistically significant(P < 0.05).In the age group 60-79,the T-value bone density of males was higher than that of females.There was no statistical significance in T value of bone mineral density between men and women in the low body weight group(P > 0.05),and there was statistical significance in T value of bone mineral density between men and women in other BMI groups(P < 0.05).There were statistically significant differences in bone mineral density T values between male and female groups in different BMI groups(P < 0.05).四、 Single factor investigation results: Among the total samples,the different bone condition detection rates of residents at different altitudes had statistical significance(P < 0.05).The detection rates of bone condition were different among residents with different occupations,whether they were engaged in farming last year,and whether they were suffering from hypertensive animal husbandry activities,with statistical significance(P <0.05).Both high density lipoprotein and low density lipoprotein were associated with bone status.There was a statistically significant difference in HDL between residents with normal bone mass and those with reduced bone mass(P < 0.05).There was a statistically significant difference between low-density lipoprotein in residents with normal bone mass and those with osteoporosis(P < 0.05).There was a statistically significant difference in the low density lipoprotein between the residents with bone loss and those with osteoporosis(P < 0.01).Among Tibetan adult female groups,the detection rates of bone condition were different among residents with different altitudes,whether menopause,whether engaged in farming and animal husbandry activities last year,and whether suffering from hypertension,with statistical significance(P < 0.05).Both triglyceride and HDL were associated with bone status.There was a statistically significant difference in triglyceride between residents with normal bone mass and those with osteoporosis(P< 0.01).There was a statistically significant difference in triglyceride between residents with bone loss and those with osteoporosis(P < 0.05).There was a statistically significant difference in HDL between residents with normal bone mass and those with reduced bone mass(P < 0.05).Among Tibetan adult male groups,the bone condition detection rates of residents with different altitudes and whether they engaged in farming and animal husbandry activities last year were different,and the difference was statistically significant(P < 0.05).Both triglyceride and low density lipoprotein were associated with bone status.There was a statistically significant difference in triglyceride between residents with normal bone mass and those with osteoporosis(P < 0.001).There was a statistically significant difference in triglyceride between residents with bone loss and those with osteoporosis(P < 0.05).There was a statistically significant difference in the low density lipoprotein between the residents with normal bone mass and those with osteoporosis(P < 0.01).There was a statistically significant difference between the low density lipoprotein of residents with bone loss and those with osteoporosis(P < 0.05).五、 logistic regression results: In the total sample,age,hypertension and low density lipoprotein were risk factors for bone loss,while body mass index and engaging in farming and animal husbandry activities in the past year were protective factors for bone loss.Age is a risk factor for osteoporosis,while body mass index and farming activities in the past year are protective factors.In females,age,hypertension and menopause were risk factors for bone loss,while body mass index and engaging in farming and animal husbandry activities in the past year were protective factors.Age and menopause are risk factors for osteoporosis,while body mass index and farming activities in the past year are protective factors.In male group,age is the risk factor of bone loss,body mass index,last year’s farming activities are protective factors of bone loss.Age is a risk factor for osteoporosis,while body mass index and farming activities in the past year are protective factors.六、 Among 466 Tibetan adult females,the actual frequency of MTHFR C677 T genotype was 249 CC genotype,198 CT genotype and 19 TT genotype.The MTHFR C677 T polymorphism in 466 Tibetan adult females did not conform to the rule of genetic balance(P < 0.05).The actual frequency of MTHFR A1298 C genotype was AA(256 cases),AC(183 cases),CC(27 cases),and 466 Tibetan adult females with MTHFR A1298 C polymorphism in accordance with the rule of genetic balance(P >0.05).Among 372 Tibetan adult males,the actual frequency of MTHFR C677 T genotype was CC in 227 cases,CT in 130 cases,TT in 15 cases,and MTHFR C677 T polymorphism in 372 Tibetan adult males was consistent with the rule of genetic balance(P > 0.05).The actual frequency of MTHFR A1298 C genotype was AA in 207 cases,AC in 139 cases,CC in 26 cases,and 372 Tibetan adult males.The polymorphism of MTHFR A1298 C was consistent with genetic balance rule(P > 0.05).The bone mineral density T values of MTHFR CT type and TT type were different in Tibetan adult female(P < 0.05).There was no difference in bone mineral density T value among different genotypes of MTHFR A1298 C in Tibetan adult female(P > 0.05).There were no significant differences in bone mineral density T values of MTHFR C677 T and A1298 C genotypes among Tibetan adult males(P > 0.05).There was no significant difference in the distribution of MTHFR C677 T and A1298 C genotypes among normal bone mass,decreased bone mass and osteoporosis in male and female populations(P > 0.05).There was no correlation between MTHFR C677 T genotype and bone mineral density T value(P > 0.05).Conclusion一、The overall prevalence of osteoporosis in high-altitude areas of Tibet is 3.5%,among which the prevalence of women is 3.7% and that of men is 3.1%.The overall prevalence of osteoporosis over 50 years old was8.3%,with 9.1% in women and 7.1% in men.The overall prevalence of osteoporosis over 60 years old was 14.7%,including 15.9% in women and12.8% in men.The prevalence of osteoporosis is low in Tibetan adults in Tibet.二、 menopause is an independent risk factor for abnormal bone mass of Tibetan adult females in this area.Age,BMI,and engaging in farming and animal husbandry activities last year are all factors that can influence bone mass of the total sample,female and male groups in this area.Hypertension is a risk factor for bone loss in the total sample,female population.In the total sample,LDL was a risk factor for bone loss.三、 Bone mineral density T values of MTHFR C677 T genotypes were different in female univariate analysis,but they were not factors affecting bone mineral density T values,suggesting that there was no correlation between MTHFR C677 T gene polymorphism and bone mass abnormality.四、The value of OSTA index and body mass index in screening osteoporosis among middle-aged and elderly Tibetan residents showed that both OSTA index and body mass index could be used for OP screening among middle-aged and elderly people in the region,and the effect of OSTA index in screening OP was better than BMI.五、 Prevention of abnormal bone mass: During the investigation,it was found that the allocation rate of bone densitometer in this area was very low,and residents’ knowledge of osteoporosis was quite weak.In Tibet,it is necessary to strengthen the publicity and equip bone density instruments for regular screening of osteoporosis among middle-aged and elderly residents.When women in their 30 s and men in their 40 s,pay attention to changes in unhealthy lifestyles(smoking cessation,alcohol restriction,high salt,high fat,etc.),a balanced diet rich in calcium and vitamin D,regular exercise,and appropriate weight control. |
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