老年女性服用钙复方制剂与BMD、BTMs及25(OH)D水平的相关性研究

摘要

Objective To investigate the bone mineral density (BMD),bone turnover markers (BTMs) and 25-hydroxy vitamin D3 [25(OH)D] levels in elderly women taking vitamin D & calcium compound preparation(calcium compound).Methods Selected the old female total 1305 women aged 65-93 years were enrolled in the study,including 384 cases taking calcium compound in the past 6 months (study group) and 921 cases not taking calcium compound (control group).The levels of BMD,procollagen type Ⅰ carboxy terminal peptide sequence specific beta (CTX),total collagen type Ⅰ N-terminal propeptide(P1NP),osteocalcin (OC),25 (OH)D and parathyroid hormone (PTH) were detected and compared between two groups,and also compared between two groups in different age groups (65-74,75-84 and 85-93).The reasons for failed adherence of administration were analyzed.Results The incidence of osteoporosis in study group was 44.53％,which was significantly lower than that in the control group (P＜0.01).Compared with the control group,the levels of BTMs (CTX,P1NP,OC) in the study group were lower (P＜0.01) and that of 25(OH) D was higher(P＜0.01).The differences of BTMs and 25(OH)D levels between two groups in all three age groups were statistically significant(P＜0.05).The common causes of failed adherence of medication were'no use or even harmful','no knowledge or no order from doctor','forget or no bother'and'causing epigastric discomfort or constipation,or too hard to swallow',accounting for 25.08％,19.54％,15.85％ and 14.88％,respectively.Conclusion Taking vitamin D & calcium compound preparation is of help to decrease the BTMs,increase serum 25 (OH) D levels,and reduce the incidence of osteoporosis in elderly women.%目的 探讨老年女性服用维生素D和钙复方制剂(以下简称钙复方制剂)与骨密度(BMD)、骨转换标志物(BTMs)及25-羟基维生素D3[25(OH)D]的相关性.方法 选择65～93岁老年女性1 305例为研究对象,根据钙复方制剂服用情况(过去6个月平均每周服用钙复方制剂≥4d为服用)分为服用组384例和未服用组921例,检测并比较两组老年女性BMD、Ⅰ型胶原羧基端肽β特殊序列(CT×)、总Ⅰ型胶原氨基端前肽(P1NP)和N端骨钙素(OC)、25(OH)D和甲状旁腺激素(PTH)水平,进一步比较服用组不同年龄段(65岁～、75岁～、85～93岁)女性BTMs、25(OH)D、PTH水平,并分析未坚持服用钙复方制剂的原因.结果 服用组骨质疏松发生率为44.53％,明显低于未服用组的57.76％(P＜0.01).与未服用组比较,服用组CTX、P1NP、OC水平较低(均P＜0.01)、25(OH)D水平较高(P＜0.01).3个年龄组间BTMs、25(OH )D水平比较,差异均有统计学意义(均P＜0.05).未坚持服用钙复方制剂的常见原因主要有“认为补钙没有用甚至可能有害”“不知道要服用或医生没有配”“常常忘记服药,或服用完后懒得再去配”“服后胃脘部不适或便秘,或药片太大难以下咽”,分别占25.08％、19.54％、15.85％和14.88％.结论 老年女性尽早服用钙复方制剂有助于降低BTMs水平,提高血清25(OH)水平,防止骨质疏松的发生.