Increased risk of osteoporotic fracture in community-dwelling elderly men 20 or more years after gastrectomy: The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study
Increased risk of osteoporotic fracture in community-dwelling elderly men 20 or more years after gastrectomy: The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study
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DOI：
10.1016/j.bone.2019.06.014
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发表时间：
2019-10-01
期刊：
影响因子：
4.1
通讯作者：
Kurumatani, Norio
中科院分区：
文献类型：
--
作者：
Iki, Masayuki;Fujita, Yuki;Kurumatani, Norio
目的：许多研究报道，有胃切除史的患者(胃切除患者)的面骨密度(ABMD)比无胃切除史的患者低，骨折风险高。然而，关于这一主题的基于人群的研究很少，而且对胃切除患者的长期骨代谢状况知之甚少。本研究旨在阐明日本社区老年男性中胃切除与骨密度、骨代谢标记物和骨折风险的关系。方法：1992名65岁男性完成了基线测量，包括脊柱和髋部的骨密度、血清完整甲状旁腺激素(PTH)、完整骨钙素(OC)、抗酒石酸酸性磷酸酶同工酶5b(TRACP5b)和羧化不足OC(UcOC)，并采访了包括胃切除术在内的既往病史。结果：剔除1型糖尿病患者和缺失骨质疏松性骨折患者后，1985名男性纳入分析，其中包括132名接受胃切除术的男性。胃切除组PTH、TRACP5b和ucoC水平显著高于非胃切除组，aBMD显著低于非胃切除组。在调整混杂变量(危险比(HR)：2.55，95%可信区间(CI)：1.17，5.55)后，胃切除与OPF的风险显著相关，当进一步调整甲状旁腺激素和aBMD时，风险不再显著。然而，即使在这个模型中，在术后存活20年或更长时间的胃切除患者中，OPF风险的增加也是显著的(HR：3.56，95%CI：1.33，9.52)。结论：在社区居住的日本老年男性中，胃切除史与骨吸收增加、aBMD降低和骨折风险增加有关。这种骨折风险的增加在胃切除术后很长一段时间内更加明显。
Purpose: Many studies have reported that patients with a history of gastrectomy (gastrectomized patients) have lower areal bone mineral density (aBMD) and higher fracture risk than those without. However, population based studies on this topic are scarce, and little is known regarding the bone metabolic status of gastrectomized patients in the long-term. This study aimed to clarify the association of gastrectomy with aBMD, bone metabolism markers, and fracture risk in community-dwelling elderly Japanese men.Methods: A total of 1992 men aged 65 years completed baseline measurements including aBMD at the spine and hip, serum levels of intact parathyroid hormone (PTH), intact osteocalcin (OC), tartrate-resistant acid phosphatase isoenzyme 5b (TRACP5b), and undercarboxylated OC (ucOC), and an interview regarding past medical history including gastrectomy. Osteoporotic fractures (OPFs) that occurred during the 5-year follow-up period were determined through structured interviews.Results: After excluding participants with type 1 diabetes mellitus and those with missing values, 1985 men, including 132 gastrectomized men, were analyzed. Gastrectomized men had significantly higher PTH, TRACP5b, and ucOC levels, and lower aBMD, than non-gastrectomized men. Gastrectomy was associated with a significantly higher risk of OPF after adjusting for confounding variables (hazard ratio (HR): 2.55, 95% confidence interval (CI): 1.17, 5.55), and the risk was no longer significant when further adjusted for PTH and aBMD. Even in this model, however, increase in OPF risk was significant in gastrectomized men who survived 20 years or more after the surgery (HR: 3.56, 95% CI: 1.33, 9.52).Conclusions: History of gastrectomy was associated with elevated bone resorption, decreased aBMD, and increased fracture risk in community-dwelling elderly Japanese men. This increase in fracture risk was more prominent long after gastrectomy.